MEDICARE: DEBRA L BENISHEK APNP

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	163W00000X	Registered Nurse	67884	WI
2	363LF0000X	Family Nurse Practitioner	1826	WI
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1826	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164441580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA L BENISHEK APNP

Provider Business Mailing Address
First Line	:	1499 6TH ST
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54304-2252
Country	:	US
Telephone Number	:	920-497-6161
Fax Number	:	920-498-0476

Provider Business Practice Location Address
First Line	:	1496 BELLEVUE ST
Second Line	:	SUITE 101
City	:	GREEN BAY
State	:	WI
Zip	:	54311-4205
Country	:	US
Telephone Number	:	920-784-2644
Fax Number	:	920-784-2655

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	11/19/2020

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