Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 5951001414 | MI |
Y | 222Z00000X | Podiatrist | 5951001414 | MI |
NPI | 1033786595 |
---|---|
Provider Name | Jessica Lynn Hoffstatter |
First Address | Stanley, WI 54768-5850 |
Second Address | Grand Blanc, MI 48439-8065 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2021 |
Last Update Date | 04/06/2021 |