Healthcare Provider Details

I. General information

NPI: 1093867335
Provider Name (Legal Business Name): KIMBERLEE HOFFMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 06/27/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 W ROLLINS RD
ROUND LAKE BEACH IL
60073-1217
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-2083
US

V. Phone/Fax

Practice location:
  • Phone: 800-323-8622
  • Fax: 224-225-0381
Mailing address:
  • Phone: 847-390-5900
  • Fax: 610-862-1547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209005457
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: