Provider Demographics
NPI:1831136969
Name:HOFFMAN, JEANETTE L (CNP)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:L
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:CUSTER
Mailing Address - State:SD
Mailing Address - Zip Code:57730-1304
Mailing Address - Country:US
Mailing Address - Phone:605-673-4150
Mailing Address - Fax:
Practice Address - Street 1:1041 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:CUSTER
Practice Address - State:SD
Practice Address - Zip Code:57730-1304
Practice Address - Country:US
Practice Address - Phone:605-673-4150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR023466363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9237729OtherDAKOTACARE
SD0040665OtherWELLMARK
SD0040728OtherWELLMARK
SD3475OtherDAKOTACARE
SD6821215Medicaid
SD6821216Medicaid
SD9237729OtherDAKOTACARE
R02622Medicare UPIN
SDS101109Medicare PIN