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NPI Code Detail

MEDICARE: SARAH BENNE CNP

MEDICARE: SARAH BENNE CNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse PractitionerCP001554SD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1740742071
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARAH BENNE CNP
Provider Business Mailing Address
First Line : 3810 JACKSON BLVD
Second Line :
City : RAPID CITY
State : SD
Zip : 57702-3246
Country : US
Telephone Number : 605-343-4050
Fax Number :
Provider Business Practice Location Address
First Line : 3810 JACKSON BLVD
Second Line :
City : RAPID CITY
State : SD
Zip : 57702-3246
Country : US
Telephone Number : 605-343-4050
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2019
Last Update Date : 04/04/2019

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