MEDICARE: MS. MARCIA A HOFFMAN GNP

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	363LG0600X	Gerontology Nurse Practitioner	R100425-4	MN

General Provider Information

NPI Number	:	1700869278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARCIA A HOFFMAN GNP

Provider Business Mailing Address
First Line	:	9201 W BROADWAY AVE
Second Line	:	SUITE 601
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55445-1923
Country	:	US
Telephone Number	:	763-587-7900
Fax Number	:

Provider Business Practice Location Address
First Line	:	3366 OAKDALE AVE N
Second Line	:	SUITE 551
City	:	ROBBINSDALE
State	:	MN
Zip	:	55422-2948
Country	:	US
Telephone Number	:	763-587-7737
Fax Number	:	763-587-7069

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

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	10/29/2013

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