Healthcare Provider Details

I. General information

NPI: 1578810750
Provider Name (Legal Business Name): LORRIE J. HOFFMAN MHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2012
Last Update Date: 06/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 W 24TH ST
PUEBLO CO
81003-1411
US

IV. Provider business mailing address

2429 S PRAIRIE AVE
PUEBLO CO
81005-2886
US

V. Phone/Fax

Practice location:
  • Phone: 719-546-4637
  • Fax: 719-546-4484
Mailing address:
  • Phone: 719-564-5070
  • Fax: 719-896-2874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number990079
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: