Provider Demographics
NPI:1265121719
Name:HOFMAIER, NICKLAUS MAXWELL
Entity type:Individual
Prefix:
First Name:NICKLAUS
Middle Name:MAXWELL
Last Name:HOFMAIER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-2594
Mailing Address - Country:US
Mailing Address - Phone:336-892-9992
Mailing Address - Fax:
Practice Address - Street 1:3901 N ELM ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-2594
Practice Address - Country:US
Practice Address - Phone:336-892-9992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-02
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IARES-30657390200000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program