Provider Demographics
NPI:1730418039
Name:HOFF, BEVERLY A (RN, CDE)
Entity type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:A
Last Name:HOFF
Suffix:
Gender:F
Credentials:RN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12255 DEPAUL DR.
Mailing Address - Street 2:SUITE 500
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2786
Mailing Address - Country:US
Mailing Address - Phone:314-209-5180
Mailing Address - Fax:314-209-5153
Practice Address - Street 1:12255 DEPAUL DR.
Practice Address - Street 2:SUITE 500
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-8232
Practice Address - Country:US
Practice Address - Phone:314-209-5180
Practice Address - Fax:314-209-5153
Is Sole Proprietor?:No
Enumeration Date:2009-12-15
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001017691163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator