1750611984 NPI number — MS. KERA LEIGH HOFF CSA

Table of content: MS. KERA LEIGH HOFF CSA (NPI 1750611984)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750611984 NPI number — MS. KERA LEIGH HOFF CSA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOFF
Provider First Name:
KERA
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CSA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GIBBS
Provider Other First Name:
KERA
Provider Other Middle Name:
LEIGH
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CSA
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1750611984
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
211 10TH AVE SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55904-4614
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-993-1289
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 W CENTER ST
Provider Second Line Business Practice Location Address:
EI-01 SURGICAL ASSISTANTS
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55902-3003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-266-2827
Provider Business Practice Location Address Fax Number:
507-266-1978
Provider Enumeration Date:
01/11/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AS0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)