Healthcare Provider Details

I. General information

NPI: 1053905786
Provider Name (Legal Business Name): LISA MARIE HOFFMAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2021
Last Update Date: 02/23/2021
Certification Date: 02/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 4TH ST
GAINESVILLE MO
65655-7418
US

IV. Provider business mailing address

153 4TH ST
GAINESVILLE MO
65655-7418
US

V. Phone/Fax

Practice location:
  • Phone: 417-274-9117
  • Fax:
Mailing address:
  • Phone: 417-274-9117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2020012828
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number214716
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: