Provider Demographics
NPI:1285079913
Name:HOFSTAD, ASHTON S (NP)
Entity type:Individual
Prefix:
First Name:ASHTON
Middle Name:S
Last Name:HOFSTAD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:CONRAD
Mailing Address - State:MT
Mailing Address - Zip Code:59425-1799
Mailing Address - Country:US
Mailing Address - Phone:406-271-3231
Mailing Address - Fax:406-271-3576
Practice Address - Street 1:805 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:CONRAD
Practice Address - State:MT
Practice Address - Zip Code:59425-1717
Practice Address - Country:US
Practice Address - Phone:406-271-3211
Practice Address - Fax:406-271-3917
Is Sole Proprietor?:No
Enumeration Date:2013-05-08
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT39699363LF0000X
MTNUR-APRN-LIC-100845363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT39699OtherMONTANA LICENSE