Provider Demographics
NPI:1184097883
Name:HOFFMANN, KATRINA E (MED, LAT)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:E
Last Name:HOFFMANN
Suffix:
Gender:F
Credentials:MED, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W323S8461 NEBO TRL
Mailing Address - Street 2:
Mailing Address - City:MUKWONAGO
Mailing Address - State:WI
Mailing Address - Zip Code:53149-9281
Mailing Address - Country:US
Mailing Address - Phone:262-225-9340
Mailing Address - Fax:
Practice Address - Street 1:3365 S 103RD ST STE 250
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53227-4161
Practice Address - Country:US
Practice Address - Phone:414-604-7512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13872255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer