Healthcare Provider Details

I. General information

NPI: 1730418039
Provider Name (Legal Business Name): BEVERLY A HOFF RN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2009
Last Update Date: 05/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12255 DEPAUL DR. SUITE 500
BRIDGETON MO
63044-8232
US

IV. Provider business mailing address

12255 DEPAUL DR. SUITE 500
BRIDGETON MO
63044-2786
US

V. Phone/Fax

Practice location:
  • Phone: 314-209-5180
  • Fax: 314-209-5153
Mailing address:
  • Phone: 314-209-5180
  • Fax: 314-209-5153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number2001017691
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: