Provider Demographics
NPI:1861430472
Name:HOEPFNER, MARIANNE (CNM, MSN)
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:HOEPFNER
Suffix:
Gender:F
Credentials:CNM, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6489
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46660-6489
Mailing Address - Country:US
Mailing Address - Phone:574-472-6700
Mailing Address - Fax:574-472-6746
Practice Address - Street 1:420 W 4TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-1948
Practice Address - Country:US
Practice Address - Phone:574-252-0300
Practice Address - Fax:574-252-0303
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN72000109367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000577786OtherBCBS
IN200532260Medicaid