Provider Demographics
NPI:1861081465
Name:HOFFNER, ALEXIS JADE
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:JADE
Last Name:HOFFNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1563 COMO AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-2546
Mailing Address - Country:US
Mailing Address - Phone:763-270-9330
Mailing Address - Fax:763-299-8621
Practice Address - Street 1:1563 COMO AVE STE 105
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-2546
Practice Address - Country:US
Practice Address - Phone:763-270-9330
Practice Address - Fax:763-299-8621
Is Sole Proprietor?:No
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist