Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 106615 | MO |
NPI | 1023276151 |
---|---|
Provider Name | Mrs. Rene L Hofstetter |
First Address | Saint Louis, MO 63110-1026 |
Second Address | Saint Louis, MO 63110-1026 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2008 |
Last Update Date | 27/05/2008 |