Provider Demographics
NPI:1992003297
Name:HOFERT, MISTY (PA-C)
Entity type:Individual
Prefix:MS
First Name:MISTY
Middle Name:
Last Name:HOFERT
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 1:30 N UNION RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5367
Mailing Address - Country:US
Mailing Address - Phone:716-565-3990
Mailing Address - Fax:716-565-3988
Practice Address - Street 1:30 N UNION RD
Practice Address - Street 2:SUITE 104
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5367
Practice Address - Country:US
Practice Address - Phone:716-565-3990
Practice Address - Fax:716-565-3988
Is Sole Proprietor?:No
Enumeration Date:2011-03-10
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014639363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant