Healthcare Provider Details

I. General information

NPI: 1467062646
Provider Name (Legal Business Name): CHRISTIAN HOFFMAN PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2020
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 SPENCER RD STE 201
SAINT PETERS MO
63376-2576
US

IV. Provider business mailing address

11094 SATURN DR
MARYLAND HEIGHTS MO
63043-1951
US

V. Phone/Fax

Practice location:
  • Phone: 636-939-2550
  • Fax:
Mailing address:
  • Phone: 618-218-4467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2020019745
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: