Healthcare Provider Details

I. General information

NPI: 1609369511
Provider Name (Legal Business Name): STEPHEN J HOFFMAN NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 06/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19265 W CAPITOL DR
BROOKFIELD WI
53045-2740
US

IV. Provider business mailing address

635 CEDAR BLUFFS WAY APT 26
SLINGER WI
53086-9155
US

V. Phone/Fax

Practice location:
  • Phone: 319-774-7879
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number199301-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: