Healthcare Provider Details

I. General information

NPI: 1699859736
Provider Name (Legal Business Name): JOHANNA HOFMANN MBA, MAC., LAC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 10/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 4TH AVE W STE. AB
OLYMPIA WA
98502-5467
US

IV. Provider business mailing address

1015 4TH AVE W STE. AB
OLYMPIA WA
98502-5467
US

V. Phone/Fax

Practice location:
  • Phone: 360-915-7794
  • Fax: 360-915-7936
Mailing address:
  • Phone: 360-915-7794
  • Fax: 360-915-7936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00000304
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: