Provider Demographics
NPI:1063796563
Name:HOFER, KRISTIN VICTORIA (PA-C)
Entity type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:VICTORIA
Last Name:HOFER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11S524 WALTER LN
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-5783
Mailing Address - Country:US
Mailing Address - Phone:815-545-5602
Mailing Address - Fax:
Practice Address - Street 1:1600 TORRENCE AVE
Practice Address - Street 2:
Practice Address - City:CALUMET CITY
Practice Address - State:IL
Practice Address - Zip Code:60409-5430
Practice Address - Country:US
Practice Address - Phone:708-915-4961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-03
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085004150363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical