Healthcare Provider Details

I. General information

NPI: 1396346987
Provider Name (Legal Business Name): AUDREY HOFFMAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AUDREY BARKER

II. Dates (important events)

Enumeration Date: 11/02/2020
Last Update Date: 11/02/2020
Certification Date: 10/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17021 LAKESIDE HILLS PLZ STE 203
OMAHA NE
68130-2390
US

IV. Provider business mailing address

17021 LAKESIDE HILLS PLZ STE 203
OMAHA NE
68130-2390
US

V. Phone/Fax

Practice location:
  • Phone: 402-235-4700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number113389
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: