Healthcare Provider Details

I. General information

NPI: 1295933455
Provider Name (Legal Business Name): LANA MARIE HOFELDT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 04/09/2021
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5170 US RT 60 EAST
HUNTINGTON WV
25705
US

IV. Provider business mailing address

5170 US ROUTE 60
HUNTINGTON WV
25705-2004
US

V. Phone/Fax

Practice location:
  • Phone: 304-528-4600
  • Fax:
Mailing address:
  • Phone: 304-528-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1313
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: