Healthcare Provider Details

I. General information

NPI: 1184795585
Provider Name (Legal Business Name): EDWARD M HOFFNER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 TRILLIUM WAY STE 205
CORBIN KY
40701-8445
US

IV. Provider business mailing address

2 TRILLIUM WAY STE 205
CORBIN KY
40701-8445
US

V. Phone/Fax

Practice location:
  • Phone: 606-523-2140
  • Fax: 606-523-2547
Mailing address:
  • Phone: 606-523-2140
  • Fax: 606-523-2547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number5044A
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: