Provider Demographics
NPI:1063557338
Name:HOFFER, LIBERTY L (PA)
Entity type:Individual
Prefix:
First Name:LIBERTY
Middle Name:L
Last Name:HOFFER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LIBERTY
Other - Middle Name:
Other - Last Name:MARCYZNSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0421
Mailing Address - Country:US
Mailing Address - Phone:509-944-8910
Mailing Address - Fax:
Practice Address - Street 1:16528 DESMET CT
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-3522
Practice Address - Country:US
Practice Address - Phone:509-252-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA573363A00000X
WAPA10005203363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8489197Medicaid
WA8489197Medicaid