Provider Demographics
NPI:1184462970
Name:HOFMANN, MELISSA
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:HOFMANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10386 STONY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:SPERRY
Mailing Address - State:IA
Mailing Address - Zip Code:52650-9851
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10386 STONY HOLLOW RD
Practice Address - Street 2:
Practice Address - City:SPERRY
Practice Address - State:IA
Practice Address - Zip Code:52650-9851
Practice Address - Country:US
Practice Address - Phone:319-601-9982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA179889363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner