Healthcare Provider Details

I. General information

NPI: 1326685892
Provider Name (Legal Business Name): ALLISON HOFFERTH FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2019
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 W 95TH ST
OAK LAWN IL
60453-2504
US

IV. Provider business mailing address

4950 W 95TH ST
OAK LAWN IL
60453-2504
US

V. Phone/Fax

Practice location:
  • Phone: 708-576-8150
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.020436
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: