MEDICARE: JENNIFER HOFFMAN RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN00162502	WA
2	163WC0400X	Case Management Registered Nurse	RN00162502	WA

General Provider Information

NPI Number	:	1568885838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER HOFFMAN RN

Provider Business Mailing Address
First Line	:	4602 ROAD K NE
Second Line	:
City	:	MOSES LAKE
State	:	WA
Zip	:	98837-9068
Country	:	US
Telephone Number	:	509-331-6102
Fax Number	:

Provider Business Practice Location Address
First Line	:	4602 ROAD K NE
Second Line	:
City	:	MOSES LAKE
State	:	WA
Zip	:	98837-9068
Country	:	US
Telephone Number	:	509-331-6102
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2014
Last Update Date	:	01/22/2014

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