Provider Demographics
NPI:1780314864
Name:CHOFFO, MIA CARA
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:CARA
Last Name:CHOFFO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 EAGLE RUN
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-0983
Mailing Address - Country:US
Mailing Address - Phone:210-665-3746
Mailing Address - Fax:
Practice Address - Street 1:922 EAGLE RUN
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-0983
Practice Address - Country:US
Practice Address - Phone:210-665-3746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant