Healthcare Provider Details

I. General information

NPI: 1316528466
Provider Name (Legal Business Name): NATHAN HOFMANN APRN FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3082 MCMURRAY DR
ANDERSON CA
96007-3544
US

IV. Provider business mailing address

3082 MCMURRAY DR
ANDERSON CA
96007-3544
US

V. Phone/Fax

Practice location:
  • Phone: 530-365-4412
  • Fax: 530-365-5186
Mailing address:
  • Phone: 530-365-4412
  • Fax: 530-365-5186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0028775
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number95031289
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: