Basic Information
| Provider Information | |||||||||
| NPI: | 1285079913 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOFSTAD | ||||||||
| FirstName: | ASHTON | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 809 SUNSET BLVD | ||||||||
| Address2: | |||||||||
| City: | CONRAD | ||||||||
| State: | MT | ||||||||
| PostalCode: | 594251799 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062713231 | ||||||||
| FaxNumber: | 4062713576 | ||||||||
| Practice Location | |||||||||
| Address1: | 805 SUNSET BLVD | ||||||||
| Address2: | |||||||||
| City: | CONRAD | ||||||||
| State: | MT | ||||||||
| PostalCode: | 594251717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062713211 | ||||||||
| FaxNumber: | 4062713917 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2013 | ||||||||
| LastUpdateDate: | 11/01/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 39699 | MT | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | NUR-APRN-LIC-100845 | MT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 39699 | 01 | MT | MONTANA LICENSE | OTHER |