Healthcare Provider Details

I. General information

NPI: 1376241349
Provider Name (Legal Business Name): VANESSA KATHERINE HOFER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 02/20/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 ROOSEVELT RD STE 3
GLEN ELLYN IL
60137-6101
US

IV. Provider business mailing address

875 ROOSEVELT RD STE 3
GLEN ELLYN IL
60137-6101
US

V. Phone/Fax

Practice location:
  • Phone: 630-262-6078
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.471420
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: