Provider Demographics
NPI:1154721868
Name:WILKES-HOFFMEISTER, CARRIE AMANDA (FNP-BC, DCNP)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:AMANDA
Last Name:WILKES-HOFFMEISTER
Suffix:
Gender:F
Credentials:FNP-BC, DCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:300 E 3RD ST
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-1510
Practice Address - Country:US
Practice Address - Phone:434-607-4599
Practice Address - Fax:434-363-4191
Is Sole Proprietor?:No
Enumeration Date:2014-08-29
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0017141658363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner