Healthcare Provider Details

I. General information

NPI: 1215692264
Provider Name (Legal Business Name): MISS WIATT KATHERINE HOFFMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2021
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 N RIVER ST
WILKES BARRE PA
18711-0800
US

IV. Provider business mailing address

8 BLACKWELL RD
FLEMINGTON NJ
08822-1954
US

V. Phone/Fax

Practice location:
  • Phone: 908-361-8913
  • Fax:
Mailing address:
  • Phone: 908-361-8913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: