Basic Information
Provider Information
NPI: 1033556295
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HOGGARTH-BALDWIN
FirstName: CANDIDA
MiddleName: D
NamePrefix:  
NameSuffix:  
Credential: FNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2605 CIRCLE DR
Address2: NORTH DAKOTA STATE HOSPITAL
City: JAMESTOWN
State: ND
PostalCode: 584016905
CountryCode: US
TelephoneNumber: 7012533650
FaxNumber: 7012533999
Practice Location
Address1: 2605 CIRCLE DR
Address2: NORTH DAKOTA STATE HOSPITAL
City: JAMESTOWN
State: ND
PostalCode: 584016905
CountryCode: US
TelephoneNumber: 7012533650
FaxNumber: 7012533999
Other Information
ProviderEnumerationDate: 05/29/2013
LastUpdateDate: 05/29/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XR33327NDY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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