Healthcare Provider Details

I. General information

NPI: 1316316698
Provider Name (Legal Business Name): BENJAMIN MURBACH AGNP-BC, A-GNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2015
Last Update Date: 03/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14310 E 42ND ST S
INDEPENDENCE MO
64055-7308
US

IV. Provider business mailing address

14310 E 42ND ST S UNIT 600
INDEPENDENCE MO
64055-7308
US

V. Phone/Fax

Practice location:
  • Phone: 816-333-9200
  • Fax:
Mailing address:
  • Phone: 816-333-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2015016104
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number2015016104
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number2015016104
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: