Provider Demographics
NPI:1417498015
Name:HOFFMANN, THERESA MARIE (MPA)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:MARIE
Last Name:HOFFMANN
Suffix:
Gender:F
Credentials:MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 TILLMAN ST
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-2417
Mailing Address - Country:US
Mailing Address - Phone:315-730-4963
Mailing Address - Fax:315-789-2499
Practice Address - Street 1:24 TILLMAN ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-2417
Practice Address - Country:US
Practice Address - Phone:315-730-4963
Practice Address - Fax:315-789-2499
Is Sole Proprietor?:No
Enumeration Date:2017-03-15
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker