Provider Demographics
NPI:1992297147
Name:HOIBERG, MISTY S
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:S
Last Name:HOIBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 WESTRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771-7541
Mailing Address - Country:US
Mailing Address - Phone:301-704-2074
Mailing Address - Fax:
Practice Address - Street 1:406 WESTRIDGE CIR
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:MD
Practice Address - Zip Code:21771-7541
Practice Address - Country:US
Practice Address - Phone:301-704-2074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-04
Last Update Date:2018-06-22
Deactivation Date:2018-06-22
Deactivation Code:
Reactivation Date:2018-06-22
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty