Basic Information
| Provider Information | |||||||||
| NPI: | 1912970286 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOFFMAN | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | N | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4390 | ||||||||
| Address2: | |||||||||
| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 897024390 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7754457650 | ||||||||
| FaxNumber: | 7758824218 | ||||||||
| Practice Location | |||||||||
| Address1: | 1470 MEDICAL PKWY | ||||||||
| Address2: | SUITE 160 | ||||||||
| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 897034648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7754457650 | ||||||||
| FaxNumber: | 7758824206 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2006 | ||||||||
| LastUpdateDate: | 09/18/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SM0705X | APN000803 | NV | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Medical-Surgical |
ID Information
| ID | Type | State | Issuer | Description | 100503923 | 05 | NV | MEDICAID |