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General NPI Number Information
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NPI Number | 1154558542
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Entity Type | Individual
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Provider Name | MARK G BENEDICT RN
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Gender | Male
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Dates
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Enumeration Date | 06/12/2009
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Last Update Date | 06/12/2009
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Provider Practice Location Address
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Address Line | 519 MAIN ST
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City | GREENFIELD
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State | IL
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Zip | 62044-1321
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Country | US
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Telephone | 217-358-3075
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Fax |
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Provider Business Mailing Address
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Address Line | 519 MAIN ST
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City | GREENFIELD
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State | IL
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Zip | 62044-1321
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Country | US
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Telephone | 217-358-3075
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 041314705
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License Number State | IL
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