Healthcare Provider Details

I. General information

NPI: 1174427694
Provider Name (Legal Business Name): EMILY BENDER NP-C
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 N INDIANA AVE
SYRACUSE IN
46567-1017
US

IV. Provider business mailing address

60723 STATE ROAD 13
GOSHEN IN
46528-6697
US

V. Phone/Fax

Practice location:
  • Phone: 574-457-5701
  • Fax:
Mailing address:
  • Phone: 574-536-9366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number28196592A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: