Healthcare Provider Details

I. General information

NPI: 1215101001
Provider Name (Legal Business Name): MARY LOUISE HOFFMAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 10/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107B ALA MALAMA ST
KAUNAKAKAI HI
96748
US

IV. Provider business mailing address

PO BOX 1509
KAUNAKAKAI HI
96748-1509
US

V. Phone/Fax

Practice location:
  • Phone: 808-553-4368
  • Fax: 888-388-2307
Mailing address:
  • Phone: 808-553-4368
  • Fax: 888-388-2307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number865
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: