Healthcare Provider Details

I. General information

NPI: 1063009330
Provider Name (Legal Business Name): ASHLEY CANDICE HINES CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2020
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3620 42ND ST S APT 203
FARGO ND
58104-7390
US

IV. Provider business mailing address

3620 42ND ST S APT 203
FARGO ND
58104-7390
US

V. Phone/Fax

Practice location:
  • Phone: 701-495-8233
  • Fax:
Mailing address:
  • Phone: 701-495-8233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number726
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: