Healthcare Provider Details

I. General information

NPI: 1407924822
Provider Name (Legal Business Name): ROSALIE GRIMES BENZ APRN-BC, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 12/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 ST. MARY
PILOT KNOB MO
63663
US

IV. Provider business mailing address

200 ST. MARY P. O. BOX 523
PILOT KNOB MO
63663-0523
US

V. Phone/Fax

Practice location:
  • Phone: 573-546-7000
  • Fax: 573-546-6420
Mailing address:
  • Phone: 573-546-7000
  • Fax: 573-546-6420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number090218
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: