Provider Demographics
NPI:1356104426
Name:HOFHEINS, JANE (RD)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:HOFHEINS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:
Other - Last Name:BRADSHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:13019 NE 114TH WAY
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-2058
Mailing Address - Country:US
Mailing Address - Phone:907-399-5253
Mailing Address - Fax:
Practice Address - Street 1:5220 NE HAZEL DELL AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-1242
Practice Address - Country:US
Practice Address - Phone:360-693-1474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61513351133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered