Healthcare Provider Details

I. General information

NPI: 1053134965
Provider Name (Legal Business Name): BEN STUDER RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2024
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16167 GOODVIEW TRL
LAKEVILLE MN
55044-8964
US

IV. Provider business mailing address

16167 GOODVIEW TRL
LAKEVILLE MN
55044-8964
US

V. Phone/Fax

Practice location:
  • Phone: 507-291-2521
  • Fax:
Mailing address:
  • Phone: 507-291-2521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number2475686
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number2475686
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: