Healthcare Provider Details

I. General information

NPI: 1528090321
Provider Name (Legal Business Name): WYNNE ANN HOFFACKER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WYNNE ANN BRINKS M.D.

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 03/13/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 4TH ST
EAST BERLIN PA
17316-9638
US

IV. Provider business mailing address

601 MEMORY LN
YORK PA
17402-2231
US

V. Phone/Fax

Practice location:
  • Phone: 717-846-4644
  • Fax: 717-259-7262
Mailing address:
  • Phone: 717-812-4900
  • Fax: 717-255-0951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD057567L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: