Provider Demographics
NPI:1487242897
Name:HEJL, CANDICE LEE
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:LEE
Last Name:HEJL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1422 4TH AVE N BSMT
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-4234
Mailing Address - Country:US
Mailing Address - Phone:701-809-6039
Mailing Address - Fax:
Practice Address - Street 1:3530 28TH ST S APT 103
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8847
Practice Address - Country:US
Practice Address - Phone:701-715-8893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-03
Last Update Date:2021-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND14746363747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant