Healthcare Provider Details

I. General information

NPI: 1730973660
Provider Name (Legal Business Name): JOSIE BENZIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4570 COUNTY ROAD 61
MOOSE LAKE MN
55767-9401
US

IV. Provider business mailing address

4570 COUNTY ROAD 61
MOOSE LAKE MN
55767-9401
US

V. Phone/Fax

Practice location:
  • Phone: 218-485-4491
  • Fax:
Mailing address:
  • Phone: 218-380-1125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number15383
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: