MEDICARE: TAMMY HALL-BENSON RN

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
1	163WD0400X	Diabetes Educator Registered Nurse	R146936-5	MN
2	171400000X	Health & Wellness Coach	39811

General Provider Information

NPI Number	:	1790151413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMY HALL-BENSON RN

Provider Business Mailing Address
First Line	:	26410 VALHALLA LN
Second Line	:
City	:	WASHBURN
State	:	WI
Zip	:	54891-6881
Country	:	US
Telephone Number	:	763-807-7798
Fax Number	:

Provider Business Practice Location Address
First Line	:	26410 VALHALLA LN
Second Line	:
City	:	WASHBURN
State	:	WI
Zip	:	54891-6881
Country	:	US
Telephone Number	:	763-807-7798
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2015
Last Update Date	:	04/08/2026

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