Healthcare Provider Details

I. General information

NPI: 1497384192
Provider Name (Legal Business Name): BENJAMIN A MARSHALL APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2020
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2660 SW 3RD ST
TOPEKA KS
66606-2442
US

IV. Provider business mailing address

2660 SW 3RD ST
TOPEKA KS
66606-2442
US

V. Phone/Fax

Practice location:
  • Phone: 785-354-0767
  • Fax:
Mailing address:
  • Phone: 785-354-0767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number79857
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN11004511
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: