Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 0101247286 | VA |
N | 111NI0900X | Internist | 0101247286 | VA |
Y | 207R00000X | Internist | M-13462 | ID |
Y | 111NI0900X | Internist | M-13462 | ID |
NPI | 1003079120 |
---|---|
Provider Name | Dr. Jennifer A Hofstra |
First Address | Meridian, ID 83642-1026 |
Second Address | Boise, ID 83706 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2008 |
Last Update Date | 23/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
-028 | TRICARE/CHAMPUS (01) | VA |
1003079120 | (05) | VA |
10060934 | OPTIMA HEALTH (01) | VA |
407988 | ANTHEM BC/BS (01) | VA |
5915448 | (05) | NC |
PAR | AETNA (01) | VA |
PAR | CIGNA (01) | VA |
PAR | CORVEL/CORCARE (01) | VA |
PAR | FIRST HEALTH COMMERCIAL/COVENTRY HEALTH/SOUTHERN HEALTH (01) | VA |
PAR | MULTIPLAN (01) | VA |
PAR | UNITED HEALTH CARE/MAMSI (01) | VA |
PAR | USA MANAGED CARE (01) | VA |
PAR | VA HEALTH NETWORK (01) | VA |
PAR | VA PREMIER HEALTH (01) | VA |