Healthcare Provider Details

I. General information

NPI: 1770832982
Provider Name (Legal Business Name): BETHANY MARIE HOFFMAN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2012
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 US HIGHWAY 27 N
MARSHALL MI
49068-9609
US

IV. Provider business mailing address

720 US HIGHWAY 27 N
MARSHALL MI
49068-9609
US

V. Phone/Fax

Practice location:
  • Phone: 269-781-6600
  • Fax:
Mailing address:
  • Phone: 269-781-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704235370
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: