Provider Demographics
NPI:1538272224
Name:HOFFMANN-DISTAD, KAREN MARIE (FNP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:MARIE
Last Name:HOFFMANN-DISTAD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:MARIE
Other - Last Name:HOFFMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:119 EAST 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55333
Mailing Address - Country:US
Mailing Address - Phone:507-557-2834
Mailing Address - Fax:
Practice Address - Street 1:1324 5TH ST N
Practice Address - Street 2:
Practice Address - City:NEW ULM
Practice Address - State:MN
Practice Address - Zip Code:56073-1514
Practice Address - Country:US
Practice Address - Phone:507-233-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 1284773363LF0000X
MN0505363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN827146100Medicaid
MN827146100Medicaid
MN500002991Medicare ID - Type Unspecified