Healthcare Provider Details

I. General information

NPI: 1386735074
Provider Name (Legal Business Name): MAURYA E. HOFNER P.A.-C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAURYA E. BEARD

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 05/22/2020
Certification Date: 05/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 S 6TH ST
SPRINGFIELD IL
62703-2403
US

IV. Provider business mailing address

1025 S 6TH ST
SPRINGFIELD IL
62703-2403
US

V. Phone/Fax

Practice location:
  • Phone: 217-528-7541
  • Fax:
Mailing address:
  • Phone: 217-528-7541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085-002395
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: