Healthcare Provider Details

I. General information

NPI: 1154003721
Provider Name (Legal Business Name): MICHELLE LYNN HOFFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2023
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 WILKINS CIR
CASPER WY
82601-1336
US

IV. Provider business mailing address

1430 WILKINS CIR
CASPER WY
82601-1336
US

V. Phone/Fax

Practice location:
  • Phone: 307-237-9583
  • Fax:
Mailing address:
  • Phone: 307-237-9583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number43046
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: