Healthcare Provider Details

I. General information

NPI: 1144784000
Provider Name (Legal Business Name): KAYLA MARIE BENZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2019
Last Update Date: 04/29/2022
Certification Date: 04/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 N 7TH ST
BISMARCK ND
58501-4423
US

IV. Provider business mailing address

PO BOX 5074
SIOUX FALLS SD
57117-5074
US

V. Phone/Fax

Practice location:
  • Phone: 701-323-5870
  • Fax:
Mailing address:
  • Phone: 701-323-5870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberR36341
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: