Provider Demographics
NPI:1376572693
Name:HOHM, JEAN MARIE (CPNP)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:MARIE
Last Name:HOHM
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:MARIE
Other - Last Name:MATTHEWS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPNP
Mailing Address - Street 1:211 FOUNDERS PARK DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-8098
Mailing Address - Country:US
Mailing Address - Phone:605-791-5959
Mailing Address - Fax:605-791-5960
Practice Address - Street 1:211 FOUNDERS PARK DR
Practice Address - Street 2:SUITE 3
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-8098
Practice Address - Country:US
Practice Address - Phone:605-791-5959
Practice Address - Fax:605-791-5960
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000223363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6702252Medicaid