Provider Demographics
NPI:1841230752
Name:HOFFMAN, JENNIFER S (CNP)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:S
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:PO BOX 3290
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-7290
Mailing Address - Country:US
Mailing Address - Phone:541-962-7845
Mailing Address - Fax:541-975-5225
Practice Address - Street 1:105 S MAJOR ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:IL
Practice Address - Zip Code:61530-1246
Practice Address - Country:US
Practice Address - Phone:309-467-4691
Practice Address - Fax:309-467-6229
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202100030NP-PP363LF0000X
IL209-000531363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL101038OtherHEALTH ALLIANCE
IL05732097OtherBC GROUP NUMBER
IL101038OtherHEALTH ALLIANCE
Q36152Medicare UPIN
K23124Medicare ID - Type Unspecified
IL212636Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER