Healthcare Provider Details

I. General information

NPI: 1740450980
Provider Name (Legal Business Name): AMANDA JANE BENSON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2008
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 W 69TH ST
SIOUX FALLS SD
57108-8148
US

IV. Provider business mailing address

4500 W 69TH ST
SIOUX FALLS SD
57108-8148
US

V. Phone/Fax

Practice location:
  • Phone: 605-977-7000
  • Fax:
Mailing address:
  • Phone: 605-977-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number91370
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: