Provider Demographics
NPI:1619954310
Name:HOFFMANN, ANISSA (PA-C)
Entity Type:Individual
Prefix:
First Name:ANISSA
Middle Name:
Last Name:HOFFMANN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 MEDICAL CENTER DR
Mailing Address - Street 2:PO BOX 800
Mailing Address - City:FAIRMONT
Mailing Address - State:MN
Mailing Address - Zip Code:56031-4575
Mailing Address - Country:US
Mailing Address - Phone:507-238-8555
Mailing Address - Fax:
Practice Address - Street 1:800 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031-4575
Practice Address - Country:US
Practice Address - Phone:507-238-8555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9460363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA041OtherCHAMPUS
MNMH9041022118OtherPREFERREDONE
MN20102OtherSIOUX VALLEY
MN124311Medicaid
IA984120Medicaid
MNHP50094OtherHEALTHPARTNERS
MN16615400Medicaid
MN16D17OLOtherBLUE CROSS
MN16D17OLOtherBLUE PLUS
MN544275OtherARAZ
MN01-13063OtherMEDICA
IA17726OtherBLUE CROSS
MN20102OtherSIOUX VALLEY
MN16D17OLOtherBLUE CROSS
IA984120Medicaid