Healthcare Provider Details

I. General information

NPI: 1780378679
Provider Name (Legal Business Name): NICOLE HOFSLIEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2995 SUB ZERO PKWY
FITCHBURG WI
53719-8801
US

IV. Provider business mailing address

2961 INDEX RD APT 304
FITCHBURG WI
53713-3217
US

V. Phone/Fax

Practice location:
  • Phone: 608-819-6394
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number16252-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: