Healthcare Provider Details

I. General information

NPI: 1689371429
Provider Name (Legal Business Name): HEIDI RENEE HOFFMAN-FUH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2023
Last Update Date: 02/13/2023
Certification Date: 10/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

562 S ELLIOTT ST
PRYOR OK
74361-6411
US

IV. Provider business mailing address

13302 E 84TH ST N APT 201
OWASSO OK
74055-8647
US

V. Phone/Fax

Practice location:
  • Phone: 918-824-8000
  • Fax:
Mailing address:
  • Phone: 918-232-6435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number210126
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: