Provider Demographics
NPI:1205261872
Name:HOFFMAN, CHANTELL MARIE (PA -C)
Entity type:Individual
Prefix:MRS
First Name:CHANTELL
Middle Name:MARIE
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:PA -C
Other - Prefix:
Other - First Name:CHANTELL
Other - Middle Name:MARIE
Other - Last Name:FUKUMAE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:767 NE ADWICK DR
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97006-9207
Mailing Address - Country:US
Mailing Address - Phone:808-206-1000
Mailing Address - Fax:
Practice Address - Street 1:2725 SW CEDAR HILLS BLVD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-1416
Practice Address - Country:US
Practice Address - Phone:503-352-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-13
Last Update Date:2024-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR222431363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant