Healthcare Provider Details

I. General information

NPI: 1023276151
Provider Name (Legal Business Name): RENE L HOFSTETTER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#1 BARNES JEWISH HOSPITAL PLAZA
SAINT LOUIS MO
63110-1026
US

IV. Provider business mailing address

216 S KINGSHIGHWAY BLVD
SAINT LOUIS MO
63110-1026
US

V. Phone/Fax

Practice location:
  • Phone: 314-419-2521
  • Fax:
Mailing address:
  • Phone: 314-419-2521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number106615
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: