Healthcare Provider Details

I. General information

NPI: 1396821211
Provider Name (Legal Business Name): GAYLE K HOFFMAN RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FOURTH AND WALNUT STREETS
LEBANON PA
17042
US

IV. Provider business mailing address

PO BOX 1281
LEBANON PA
17042-1281
US

V. Phone/Fax

Practice location:
  • Phone: 717-270-7706
  • Fax: 717-270-7978
Mailing address:
  • Phone: 717-270-7706
  • Fax: 717-270-7978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN000464
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: