Healthcare Provider Details

I. General information

NPI: 1316249543
Provider Name (Legal Business Name): ANGELA HOFFMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2010
Last Update Date: 11/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1899 RUSH LAKE DR
RIPON WI
54971-9138
US

IV. Provider business mailing address

1899 RUSH LAKE DR
RIPON WI
54971-9138
US

V. Phone/Fax

Practice location:
  • Phone: 920-410-6172
  • Fax:
Mailing address:
  • Phone: 920-410-6172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number130681-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: