Healthcare Provider Details

I. General information

NPI: 1659784379
Provider Name (Legal Business Name): KRISTIN RUTH TEN BENSEL R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2014
Last Update Date: 06/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 MAIN ST
CHARLESTOWN MA
02129-1125
US

IV. Provider business mailing address

39 AUBIN ST
AMESBURY MA
01913-2921
US

V. Phone/Fax

Practice location:
  • Phone: 617-426-0600
  • Fax: 617-426-3097
Mailing address:
  • Phone: 978-388-3742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number185846
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: