Healthcare Provider Details

I. General information

NPI: 1568885838
Provider Name (Legal Business Name): JENNIFER HOFFMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2014
Last Update Date: 01/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4602 ROAD K NE
MOSES LAKE WA
98837-9068
US

IV. Provider business mailing address

4602 ROAD K NE
MOSES LAKE WA
98837-9068
US

V. Phone/Fax

Practice location:
  • Phone: 509-331-6102
  • Fax:
Mailing address:
  • Phone: 509-331-6102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00162502
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN00162502
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: