Healthcare Provider Details

I. General information

NPI: 1093780967
Provider Name (Legal Business Name): THERESA MENAVICH HOFFMAN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: THERESA HELENE MENAVICH CRNP

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 05/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 N FRANKLIN ST
WEST CHESTER PA
19380-2334
US

IV. Provider business mailing address

411 E TURNBERRY CT
WEST CHESTER PA
19382-2315
US

V. Phone/Fax

Practice location:
  • Phone: 610-696-5211
  • Fax:
Mailing address:
  • Phone: 610-793-0764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberSP003495H
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: