MEDICARE: TAMELA ANNELLE BENGE LPN

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	164W00000X	Licensed Practical Nurse	130524	OH

General Provider Information

NPI Number	:	1457641078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMELA ANNELLE BENGE LPN

Provider Business Mailing Address
First Line	:	6387 LIBERTY FAIRFIELD RD
Second Line	:
City	:	LIBERTY TWP
State	:	OH
Zip	:	45011-5151
Country	:	US
Telephone Number	:	513-844-8467
Fax Number	:

Provider Business Practice Location Address
First Line	:	6387 LIBERTY FAIRFIELD RD
Second Line	:
City	:	LIBERTY TWP
State	:	OH
Zip	:	45011-5151
Country	:	US
Telephone Number	:	513-844-8467
Fax Number	:

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

Provider Enumeration Date	:	04/16/2011
Last Update Date	:	04/16/2011

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