Provider Demographics
NPI:1649214347
Name:HINES, CANDACE KINAL (PNP)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:KINAL
Last Name:HINES
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 LINWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209-2027
Mailing Address - Country:US
Mailing Address - Phone:716-932-6423
Mailing Address - Fax:716-932-6007
Practice Address - Street 1:237 LINWOOD AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-2027
Practice Address - Country:US
Practice Address - Phone:716-932-6423
Practice Address - Fax:716-932-6007
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF380915-1363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics