Healthcare Provider Details

I. General information

NPI: 1053587048
Provider Name (Legal Business Name): MARCY J BENTS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARCY J MILLER CNP

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 06/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 WOODWINDS DR
WOODBURY MN
55125-2270
US

IV. Provider business mailing address

3190 FRONTIER DR
WOODBURY MN
55129-7787
US

V. Phone/Fax

Practice location:
  • Phone: 651-232-0100
  • Fax:
Mailing address:
  • Phone: 651-253-0958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR122149-3
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: