Healthcare Provider Details

I. General information

NPI: 1205358785
Provider Name (Legal Business Name): RACHEL LYNN BENSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL LYNN CAISSIE

II. Dates (important events)

Enumeration Date: 07/17/2017
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 ELM STREETN
FARGO ND
58102-2417
US

IV. Provider business mailing address

2101 ELM ST N
FARGO ND
58102-2498
US

V. Phone/Fax

Practice location:
  • Phone: 775-982-5000
  • Fax: 775-982-5225
Mailing address:
  • Phone: 775-982-5262
  • Fax: 775-982-5496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number19947
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14658
License Number StateND
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number19947
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: