Provider Demographics
NPI:1699859736
Name:HOFMANN, JOHANNA (MBA, MAC, LAC)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:
Last Name:HOFMANN
Suffix:
Gender:F
Credentials:MBA, MAC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 4TH AVE W
Mailing Address - Street 2:STE. AB
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-5467
Mailing Address - Country:US
Mailing Address - Phone:360-915-7794
Mailing Address - Fax:360-915-7936
Practice Address - Street 1:1015 4TH AVE W
Practice Address - Street 2:STE. AB
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-5467
Practice Address - Country:US
Practice Address - Phone:360-915-7794
Practice Address - Fax:360-915-7936
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00000304171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist