Provider Demographics
NPI:1376876862
Name:HOFFACKER, THERESA M (MAED)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:M
Last Name:HOFFACKER
Suffix:
Gender:F
Credentials:MAED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1690 S TELSHOR BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4889
Mailing Address - Country:US
Mailing Address - Phone:575-556-8470
Mailing Address - Fax:
Practice Address - Street 1:1690 S TELSHOR BLVD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4889
Practice Address - Country:US
Practice Address - Phone:575-556-8470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator