Healthcare Provider Details

I. General information

NPI: 1487421152
Provider Name (Legal Business Name): MARY G. HOFFMANN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2023
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 S 200 E STE 250
SALT LAKE CITY UT
84111-3846
US

IV. Provider business mailing address

520 S ORCHARD DR UNIT 3
BOUNTIFUL UT
84010-5186
US

V. Phone/Fax

Practice location:
  • Phone: 801-359-2256
  • Fax:
Mailing address:
  • Phone: 801-671-0555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number4885077-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: