Individual
CANDACE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
13133 N PORT WASHINGTON RD, SUITE G-18, MEQUON, WI 53097-2419
(262) 243-5000
(262) 243-5026
Mailing address
788 N JEFFERSON ST, SUITE 300 / ATTN. KAAREN BUTZEN, MILWAUKEE, WI 53202-3718
(414) 272-8950
(414) 272-0859
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
3905
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1285962605
—
WI
Enumeration date
11/23/2009
Last updated
02/25/2013
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