Healthcare Provider Details

I. General information

NPI: 1679530828
Provider Name (Legal Business Name): DANIEL A BENZ CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 DIXMYTH AVENUE
CINCINNATI OH
45220-2475
US

IV. Provider business mailing address

PO BOX 640738
CINCINNATI OH
45264-0738
US

V. Phone/Fax

Practice location:
  • Phone: 513-872-2432
  • Fax: 513-872-8857
Mailing address:
  • Phone: 937-293-0247
  • Fax: 937-293-0960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN 211478
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: