Healthcare Provider Details

I. General information

NPI: 1184097883
Provider Name (Legal Business Name): KATRINA E HOFFMANN MED, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2015
Last Update Date: 11/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3365 S 103RD ST STE 250
MILWAUKEE WI
53227-4161
US

IV. Provider business mailing address

W323S8461 NEBO TRL
MUKWONAGO WI
53149-9281
US

V. Phone/Fax

Practice location:
  • Phone: 414-604-7512
  • Fax:
Mailing address:
  • Phone: 262-225-9340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1387
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: