Healthcare Provider Details

I. General information

NPI: 1033409743
Provider Name (Legal Business Name): AMY ELIZABETH HOFFMAN LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2011
Last Update Date: 04/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 NE 78TH ST
VANCOUVER WA
98665-9666
US

IV. Provider business mailing address

14802 NE 80TH CIR
VANCOUVER WA
98682-3465
US

V. Phone/Fax

Practice location:
  • Phone: 360-573-4806
  • Fax:
Mailing address:
  • Phone: 360-606-3683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60063243
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: