Healthcare Provider Details

I. General information

NPI: 1396231981
Provider Name (Legal Business Name): BONNIE HOFFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2018
Last Update Date: 07/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 N MENTZER ST
MITCHELL SD
57301-8001
US

IV. Provider business mailing address

110 N MENTZER ST
MITCHELL SD
57301-8001
US

V. Phone/Fax

Practice location:
  • Phone: 605-995-3021
  • Fax:
Mailing address:
  • Phone: 605-995-3021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR022541
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: