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General NPI Number Information
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NPI Number | 1801338769
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Entity Type | Individual
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Provider Name | DR. BENJAMIN RIEBESEL
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Gender | Male
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Dates
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Enumeration Date | 11/09/2016
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Last Update Date | 03/11/2024
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Provider Practice Location Address
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Address Line | 5734 COVENTRY LN
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City | FORT WAYNE
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State | IN
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Zip | 46804-7141
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Country | US
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Telephone | 260-435-7973
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Fax |
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Provider Business Mailing Address
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Address Line | 12063 LOWER HUNTINGTON RD
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City | ROANOKE
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State | IN
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Zip | 46783-9667
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Country | US
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Telephone | 251-599-6756
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 28232032A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 28232032A
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License Number State | IN
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