=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841601176
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NANCY BENTER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2014
-----------------------------------------------------
Last Update Date | 05/08/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 145 W 5 ST
-----------------------------------------------------
City | BURKE
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57523-0147
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-775-2228
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 145 W 5TH ST.
-----------------------------------------------------
City | BURKE
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57523-0147
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-775-2228
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WH0200X
-----------------------------------------------------
Taxonomy Name | Home Health Registered Nurse
-----------------------------------------------------
License Number | SD-RNR025938
-----------------------------------------------------
License Number State | SD
-----------------------------------------------------