Provider Demographics
NPI:1659969079
Name:HINES, CANDICE ANJANETTE GULLEY (RN)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:ANJANETTE GULLEY
Last Name:HINES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 ARBOR GREENE DR
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-7112
Mailing Address - Country:US
Mailing Address - Phone:919-740-6075
Mailing Address - Fax:
Practice Address - Street 1:122 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-3238
Practice Address - Country:US
Practice Address - Phone:919-977-4119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-03
Last Update Date:2021-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC241257163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse