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General NPI Number Information
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NPI Number | 1730973660
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Entity Type | Individual
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Provider Name | JOSIE BENZIE
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Gender | Female
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Dates
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Enumeration Date | 04/07/2025
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Last Update Date | 06/19/2025
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Provider Practice Location Address
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Address Line | 4570 COUNTY ROAD 61
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City | MOOSE LAKE
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State | MN
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Zip | 55767-9401
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Country | US
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Telephone | 218-485-4491
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Fax |
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Provider Business Mailing Address
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Address Line | 94537 ISLAND LAKE ROAD
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City | STURGEON LAKE
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State | MN
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Zip | 55783
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Country | US
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Telephone | 218-380-1125
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 15383
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License Number State | MN
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