MEDICARE: JEANETTE L HOFFMAN CNP

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	363L00000X	Nurse Practitioner	R023466	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9237729	OTHER	SD	DAKOTACARE
2	0040665	OTHER	SD	WELLMARK
3	0040728	OTHER	SD	WELLMARK
4	3475	OTHER	SD	DAKOTACARE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831136969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANETTE L HOFFMAN CNP

Provider Business Mailing Address
First Line	:	1041 MONTGOMERY ST
Second Line	:
City	:	CUSTER
State	:	SD
Zip	:	57730-1304
Country	:	US
Telephone Number	:	605-673-4150
Fax Number	:

Provider Business Practice Location Address
First Line	:	1041 MONTGOMERY ST
Second Line	:
City	:	CUSTER
State	:	SD
Zip	:	57730-1304
Country	:	US
Telephone Number	:	605-673-4150
Fax Number	:

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

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	02/27/2008

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