Provider Demographics
NPI:1184795585
Name:HOFFNER, EDWARD M (CRNA)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:M
Last Name:HOFFNER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 TRILLIUM WAY STE 205
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-8445
Mailing Address - Country:US
Mailing Address - Phone:606-523-2140
Mailing Address - Fax:606-523-2547
Practice Address - Street 1:2 TRILLIUM WAY STE 205
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-8445
Practice Address - Country:US
Practice Address - Phone:606-523-2140
Practice Address - Fax:606-523-2547
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5044A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY075336OtherAANA CERTIFICATION
KY5044AOtherARNP LICENSE