Healthcare Provider Details

I. General information

NPI: 1194722272
Provider Name (Legal Business Name): NANCY BENTON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 02/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 JOHNSON RD
STEUBENVILLE OH
43952-2364
US

IV. Provider business mailing address

PO BOX 4267
STEUBENVILLE OH
43952-8267
US

V. Phone/Fax

Practice location:
  • Phone: 740-264-8067
  • Fax: 740-346-0413
Mailing address:
  • Phone: 304-723-6040
  • Fax: 304-723-6039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number30941
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.03535
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: