Individual
CANDACE ANN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 805-8710
(414) 805-1101
Mailing address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 805-8710
(414) 805-1101
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5185
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1376166579
—
WI
Enumeration date
05/21/2020
Last updated
04/22/2022
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