MEDICARE: BOBBIE CRYSTAL HOFFMAN

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	2472R0900X	Renal Dialysis Technician

General Provider Information

NPI Number	:	1457204091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BOBBIE CRYSTAL HOFFMAN

Provider Business Mailing Address
First Line	:	W9798 COUNTY ROAD Q
Second Line	:
City	:	POUND
State	:	WI
Zip	:	54161-9518
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	W7305 ELM AVE
Second Line	:
City	:	SHAWANO
State	:	WI
Zip	:	54166-1024
Country	:	US
Telephone Number	:	715-526-4310
Fax Number	:

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

Provider Enumeration Date	:	02/16/2026
Last Update Date	:	02/16/2026

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Directions to “ BOBBIE CRYSTAL HOFFMAN ” Practice Location

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