Healthcare Provider Details

I. General information

NPI: 1346864956
Provider Name (Legal Business Name): RACHEL C HOFMAIER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2020
Last Update Date: 09/13/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2506 PAYNE ST
EVANSTON IL
60201-2131
US

IV. Provider business mailing address

2506 PAYNE ST
EVANSTON IL
60201-2131
US

V. Phone/Fax

Practice location:
  • Phone: 847-321-5966
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: