Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 265996 | MA |
Y | 2080P0204X | Pediatric Emergency Doctor | 036.148093 | IL |
NPI | 1184966913 |
---|---|
Provider Name | Jennifer Ann Hoffmann |
First Address | Chicago, IL 60611-2991 |
Second Address | Chicago, IL 60611 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2013 |
Last Update Date | 28/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110122507A | (05) | MA |