Healthcare Provider Details

I. General information

NPI: 1417412602
Provider Name (Legal Business Name): KARIN BENNER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2019
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

784 MEDINA RD STE 104
MEDINA OH
44256-9634
US

IV. Provider business mailing address

784 MEDINA RD STE 104
MEDINA OH
44256-9634
US

V. Phone/Fax

Practice location:
  • Phone: 330-661-4008
  • Fax: 330-661-4049
Mailing address:
  • Phone: 330-661-4008
  • Fax: 330-661-4049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.024619
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.304080
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: