Provider Demographics
NPI:1770832982
Name:HOFFMAN, BETHANY MARIE (FNP-BC)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:MARIE
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 US HIGHWAY 27 N
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-9609
Mailing Address - Country:US
Mailing Address - Phone:269-781-6600
Mailing Address - Fax:
Practice Address - Street 1:720 US HIGHWAY 27 N
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MI
Practice Address - Zip Code:49068-9609
Practice Address - Country:US
Practice Address - Phone:269-781-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-04
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704235370363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0A37669Medicare PIN