Healthcare Provider Details

I. General information

NPI: 1194223024
Provider Name (Legal Business Name): MRS. ALISSA HOFF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2018
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1595 MN 36 - 584 10 ROSEDALE CENTER
ROSEVILLE MN
55113
US

IV. Provider business mailing address

5405 10TH AVE S
MINNEAPOLIS MN
55417-2413
US

V. Phone/Fax

Practice location:
  • Phone: 651-697-0030
  • Fax:
Mailing address:
  • Phone: 651-697-0030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: