Provider Demographics
NPI:1801079629
Name:HINDS, ANGELIQUE CHAMPEAU (CPNP)
Entity type:Individual
Prefix:
First Name:ANGELIQUE
Middle Name:CHAMPEAU
Last Name:HINDS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:ANGELIQUE
Other - Middle Name:MARIE
Other - Last Name:CHAMPEAU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:744 52ND ST STE 4100
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1810
Mailing Address - Country:US
Mailing Address - Phone:510-428-3402
Mailing Address - Fax:510-597-7089
Practice Address - Street 1:744 52ND ST STE 4100
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1810
Practice Address - Country:US
Practice Address - Phone:510-428-3402
Practice Address - Fax:510-597-7089
Is Sole Proprietor?:No
Enumeration Date:2007-12-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN455853 NPF 7800363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA455853OtherRN
CA7800OtherNPF
CAMH1457236OtherDEA
CAS93241Medicare UPIN