Healthcare Provider Details

I. General information

NPI: 1063557338
Provider Name (Legal Business Name): LIBERTY L HOFFER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LIBERTY MARCYZNSKI

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 08/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16528 DESMET CT
SPOKANE VALLEY WA
99216-3522
US

IV. Provider business mailing address

PO BOX 421
LIBERTY LAKE WA
99019-0421
US

V. Phone/Fax

Practice location:
  • Phone: 509-252-1900
  • Fax:
Mailing address:
  • Phone: 509-944-8910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA573
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA10005203
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: