Healthcare Provider Details

I. General information

NPI: 1801979257
Provider Name (Legal Business Name): MARY SUE BENSON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 W CEDAR LOOP
CHEROKEE IA
51012-1566
US

IV. Provider business mailing address

427 GILLEASE ST
CHEROKEE IA
51012-1113
US

V. Phone/Fax

Practice location:
  • Phone: 712-225-2594
  • Fax: 712-225-6933
Mailing address:
  • Phone: 712-225-5946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA059348
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: