Healthcare Provider Details

I. General information

NPI: 1639887896
Provider Name (Legal Business Name): RYAN HOFFMAN FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2022
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5557 W 4100 S
WEST VALLEY CITY UT
84120-4629
US

IV. Provider business mailing address

1064 E 1200 N
OGDEN UT
84404-3327
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone: 717-443-1479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP025667
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number13012445-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: