Healthcare Provider Details

I. General information

NPI: 1245806009
Provider Name (Legal Business Name): TRACI HOFER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 06/02/2021
Certification Date: 05/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 HUNTER LN
CAMP HILL PA
17011-2400
US

IV. Provider business mailing address

2724 TREMONT ST
PHILADELPHIA PA
19136-1023
US

V. Phone/Fax

Practice location:
  • Phone: 800-748-3243
  • Fax:
Mailing address:
  • Phone: 215-880-6337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN546493
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: