Provider Demographics
NPI:1831499953
Name:HOFER, DEBRA LYNNE (RD/LD)
Entity type:Individual
Prefix:MISS
First Name:DEBRA
Middle Name:LYNNE
Last Name:HOFER
Suffix:
Gender:F
Credentials:RD/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 N YORK ST
Mailing Address - Street 2:STE 20
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-3123
Mailing Address - Country:US
Mailing Address - Phone:918-913-9109
Mailing Address - Fax:918-913-9112
Practice Address - Street 1:928 N YORK ST
Practice Address - Street 2:STE 20
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-3123
Practice Address - Country:US
Practice Address - Phone:918-913-9109
Practice Address - Fax:918-913-9112
Is Sole Proprietor?:No
Enumeration Date:2010-10-22
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1696133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200511430AMedicaid