Healthcare Provider Details

I. General information

NPI: 1942908959
Provider Name (Legal Business Name): ALEXANDRA LISA HOF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 02/20/2023
Certification Date: 02/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15945 CLAYTON RD STE 340
BALLWIN MO
63011-2492
US

IV. Provider business mailing address

6637 LINDENWOOD PL
SAINT LOUIS MO
63109-1223
US

V. Phone/Fax

Practice location:
  • Phone: 636-256-5130
  • Fax: 636-256-5147
Mailing address:
  • Phone: 973-934-0334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2023006112
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: