Healthcare Provider Details

I. General information

NPI: 1518689389
Provider Name (Legal Business Name): STEPHANIE HOFNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2022
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6303 4TH ST NW STE 1
LOS RANCHOS NM
87107-5855
US

IV. Provider business mailing address

6303 4TH ST NW STE 1
LOS RANCHOS NM
87107-5855
US

V. Phone/Fax

Practice location:
  • Phone: 505-903-4413
  • Fax:
Mailing address:
  • Phone: 505-903-4413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: