Healthcare Provider Details

I. General information

NPI: 1184462970
Provider Name (Legal Business Name): MELISSA HOFMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2024
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10386 STONY HOLLOW RD
SPERRY IA
52650-9851
US

IV. Provider business mailing address

10386 STONY HOLLOW RD
SPERRY IA
52650-9851
US

V. Phone/Fax

Practice location:
  • Phone: 319-601-9982
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA179889
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: