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General NPI Number Information
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NPI Number | 1629707849
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Entity Type | Individual
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Provider Name | EMMA B BENGTSON PHYSICIAN ASSISTANT
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Gender | Female
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Dates
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Enumeration Date | 06/06/2022
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Last Update Date | 10/13/2023
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Provider Practice Location Address
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Address Line | 1521 CARLSON ST
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City | MARSHALL
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State | MN
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Zip | 56258-2626
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Country | US
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Telephone | 507-476-4800
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Fax |
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Provider Business Mailing Address
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Address Line | 2355 US HIGHWAY 59
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City | GARVIN
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State | MN
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Zip | 56132-1161
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Country | US
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Telephone | 402-871-0617
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 14678
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License Number State | MN
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