Healthcare Provider Details

I. General information

NPI: 1346491271
Provider Name (Legal Business Name): LISA DIANE (COBB-MAIDEN) HOFFMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA COBB BUGNER

II. Dates (important events)

Enumeration Date: 10/09/2008
Last Update Date: 10/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91-2301 OLD FT WEAVER RD
EWA BEACH HI
96706-3602
US

IV. Provider business mailing address

91-1155 HOOMAHANA ST
EWA BEACH HI
96706-4630
US

V. Phone/Fax

Practice location:
  • Phone: 808-671-8511
  • Fax: 808-677-2570
Mailing address:
  • Phone: 808-685-0855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN-63380
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: