MEDICARE: ELIZABETH ANN FAIRMAN-HOFFMAN R.N., C.N.M., M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367A00000X	Advanced Practice Midwife	236308	TX

General Provider Information

NPI Number	:	1316958911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH ANN FAIRMAN-HOFFMAN R.N., C.N.M., M.S.

Provider Business Mailing Address
First Line	:	PO BOX 961205
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76161-1205
Country	:	US
Telephone Number	:	817-740-8400
Fax Number	:	817-378-3699

Provider Business Practice Location Address
First Line	:	1050 S. 5TH AVE
Second Line	:	SUITE K
City	:	FORT WORTH
State	:	TX
Zip	:	76104
Country	:	US
Telephone Number	:	817-332-6696
Fax Number	:	817-332-6616

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	11/02/2007

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