Provider Demographics
NPI:1649872987
Name:HOFFNER, AMBER ROSE (QSP)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:ROSE
Last Name:HOFFNER
Suffix:
Gender:F
Credentials:QSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 S 12TH ST LOT 23
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-5964
Mailing Address - Country:US
Mailing Address - Phone:701-240-1645
Mailing Address - Fax:
Practice Address - Street 1:725 S 12TH ST LOT 23
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-5964
Practice Address - Country:US
Practice Address - Phone:701-240-1645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND14710773747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1471077Medicaid