Healthcare Provider Details

I. General information

NPI: 1194596114
Provider Name (Legal Business Name): BRYNA ALYSE BENNINGHOFF RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2024
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 W STRUB RD BUILDING ONE, SUITE B
SANDUSKY OH
44870-5390
US

IV. Provider business mailing address

302 LOUISE AVE
BELLEVUE OH
44811-1830
US

V. Phone/Fax

Practice location:
  • Phone: 567-998-3900
  • Fax: 567-998-3899
Mailing address:
  • Phone: 419-271-1779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0040180
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.367755
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: