Provider Demographics
NPI:1487296273
Name:HOFMANN, TAMMY (RN- BSN)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:HOFMANN
Suffix:
Gender:F
Credentials:RN- BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174208 SHADY LN
Mailing Address - Street 2:
Mailing Address - City:HATLEY
Mailing Address - State:WI
Mailing Address - Zip Code:54440-5199
Mailing Address - Country:US
Mailing Address - Phone:715-432-5911
Mailing Address - Fax:
Practice Address - Street 1:5850 DAVID DR
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-9013
Practice Address - Country:US
Practice Address - Phone:715-432-5911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-13
Last Update Date:2019-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI149579-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse