Healthcare Provider Details

I. General information

NPI: 1801494760
Provider Name (Legal Business Name): ELIZABETH BENEPE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2020
Last Update Date: 10/13/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 7TH AVE
NEWPORT MN
55055-1430
US

IV. Provider business mailing address

311 7TH AVE
NEWPORT MN
55055-1430
US

V. Phone/Fax

Practice location:
  • Phone: 763-244-0454
  • Fax:
Mailing address:
  • Phone: 763-244-0454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: