Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 104573545 | SD |
NPI | 1134792062 |
---|---|
Provider Name | Leslie Benson |
First Address | Gillette, WY 82718-5707 |
Second Address | Rapid City, SD 57701-7375 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2021 |
Last Update Date | 19/07/2021 |