Healthcare Provider Details

I. General information

NPI: 1336360841
Provider Name (Legal Business Name): SUSAN CAMILLE HOFFNER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3285 E SPARROW AVE
FLAGSTAFF AZ
86004-7794
US

IV. Provider business mailing address

3285 E SPARROW AVE
FLAGSTAFF AZ
86004-7794
US

V. Phone/Fax

Practice location:
  • Phone: 928-773-8202
  • Fax: 928-773-8247
Mailing address:
  • Phone: 928-773-8202
  • Fax: 928-773-8247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN102899
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: