Healthcare Provider Details

I. General information

NPI: 1386234037
Provider Name (Legal Business Name): STEPHANIE HOFF GRIESBACH CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STEPHANIE HOFF PEDERSEN CPNP-PC

II. Dates (important events)

Enumeration Date: 01/26/2021
Last Update Date: 04/25/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 GILLHAM RD
KANSAS CITY MO
64108-4619
US

IV. Provider business mailing address

P.O. BOX 804435
KANSAS CITY MO
64180-4435
US

V. Phone/Fax

Practice location:
  • Phone: 816-701-5100
  • Fax: 816-302-9939
Mailing address:
  • Phone: 816-701-5100
  • Fax: 816-302-9939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number53-79907-022
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2021004837
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number53-79907-022
License Number StateKS
# 4
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number2021004837
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: