Healthcare Provider Details

I. General information

NPI: 1083933394
Provider Name (Legal Business Name): VICKI HOFMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2010
Last Update Date: 05/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 23RD DR W STE 104
EVERETT WA
98203-1584
US

IV. Provider business mailing address

5801 23RD DR W STE 104
EVERETT WA
98203-1584
US

V. Phone/Fax

Practice location:
  • Phone: 425-513-8213
  • Fax: 425-513-0534
Mailing address:
  • Phone: 425-513-8213
  • Fax: 425-513-0534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberCG60151301
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: