=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154452613
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAY BENSCHOP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2007
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1953 UNIVERSITY AVE W
-----------------------------------------------------
City | SAINT PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55104-3427
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-659-0208
-----------------------------------------------------
Fax | 651-659-0161
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2339 TART LAKE RD
-----------------------------------------------------
City | LINO LAKES
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55038-7730
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WH0200X
-----------------------------------------------------
Taxonomy Name | Home Health Registered Nurse
-----------------------------------------------------
License Number | R 125764-5
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------