Healthcare Provider Details

I. General information

NPI: 1821623778
Provider Name (Legal Business Name): AILEEN HOFFMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2020
Last Update Date: 04/12/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1633 N CAPITOL AVE STE 640
INDIANAPOLIS IN
46202-1281
US

IV. Provider business mailing address

1633 N CAPITOL AVE STE 640
INDIANAPOLIS IN
46202-1281
US

V. Phone/Fax

Practice location:
  • Phone: 317-962-8881
  • Fax:
Mailing address:
  • Phone: 173-962-8881
  • Fax: 317-962-0838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: