Healthcare Provider Details

I. General information

NPI: 1497677488
Provider Name (Legal Business Name): MARCIE BENNETHUM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 HIGHVIEW DR
SLINGER WI
53086-9401
US

IV. Provider business mailing address

629 HIGHVIEW DR
SLINGER WI
53086-9401
US

V. Phone/Fax

Practice location:
  • Phone: 262-391-7633
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number176633-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: