MEDICARE: CARLIE JO HOFFMAN RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	2542963	MN
2	163W00000X	Registered Nurse	R56024	ND

General Provider Information

NPI Number	:	1295694511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLIE JO HOFFMAN RN

Provider Business Mailing Address
First Line	:	614 23RD AVE S
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58201-7412
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 CHERRY ST
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58201-7400
Country	:	US
Telephone Number	:	701-317-6561
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2026
Last Update Date	:	01/21/2026

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