Healthcare Provider Details

I. General information

NPI: 1801336243
Provider Name (Legal Business Name): MICHELLE HOFF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2017
Last Update Date: 03/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 ARSENAL ST
SAINT LOUIS MO
63139-1463
US

IV. Provider business mailing address

10277 BOHR RD
MINERAL POINT MO
63660-9486
US

V. Phone/Fax

Practice location:
  • Phone: 314-877-5728
  • Fax:
Mailing address:
  • Phone: 573-747-6227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2016034745
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: