Healthcare Provider Details

I. General information

NPI: 1093066946
Provider Name (Legal Business Name): JULIE KRISTIN BENGE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2012
Last Update Date: 06/12/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

865 S PATTERSON BLVD
DAYTON OH
45402-2624
US

IV. Provider business mailing address

DECOACH REHABILITATION CENTRE 100 CROWNE POINT PL
CINCINNATI OH
45241
US

V. Phone/Fax

Practice location:
  • Phone: 937-966-4673
  • Fax:
Mailing address:
  • Phone: 513-743-7628
  • Fax: 937-734-4343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number411865
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN126408
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: