=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679901862
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHERYL L. BENFIELD RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2013
-----------------------------------------------------
Last Update Date | 10/24/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2853 CR 3900
-----------------------------------------------------
City | INDEPENDENCE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67301-7595
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-331-9070
-----------------------------------------------------
Fax | 620-331-9070
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2853 CR 3900
-----------------------------------------------------
City | INDEPENDENCE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67301-7595
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-331-9070
-----------------------------------------------------
Fax | 620-331-9070
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251C00000X
-----------------------------------------------------
Taxonomy Name | Developmentally Disabled Services Day Training Agency
-----------------------------------------------------
License Number | 200713460A
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 311ZA0620X
-----------------------------------------------------
Taxonomy Name | Adult Care Home Facility
-----------------------------------------------------
License Number | 200713460A
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3747P1801X
-----------------------------------------------------
Taxonomy Name | Personal Care Attendant
-----------------------------------------------------
License Number | 200713460A
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 13-44466-101
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------