Healthcare Provider Details

I. General information

NPI: 1699762450
Provider Name (Legal Business Name): MARY P. HOFFMAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 03/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N 17TH ST
ALLENTOWN PA
18104-5052
US

IV. Provider business mailing address

1245 S CEDAR CREST BLVD SUITE #301
ALLENTOWN PA
18103-6258
US

V. Phone/Fax

Practice location:
  • Phone: 610-402-9099
  • Fax: 610-402-9029
Mailing address:
  • Phone: 610-402-9099
  • Fax: 610-402-9029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN212010L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number039844
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: