Healthcare Provider Details

I. General information

NPI: 1073098943
Provider Name (Legal Business Name): DIXIE HOFER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2018
Last Update Date: 09/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7380 SW 163RD PL
BEAVERTON OR
97007-6365
US

IV. Provider business mailing address

7380 SW 163RD PL
BEAVERTON OR
97007-6365
US

V. Phone/Fax

Practice location:
  • Phone: 503-848-7069
  • Fax:
Mailing address:
  • Phone: 503-848-7069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number000034729RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: