Basic Information
| Provider Information | |||||||||
| NPI: | 1356322580 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BENZ | ||||||||
| FirstName: | NICOLLE | ||||||||
| MiddleName: | ROCINA MARLENE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 421 | ||||||||
| Address2: | |||||||||
| City: | LIBERTY LAKE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 990190421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8667472455 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 101 W 8TH AVE | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992042307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094743260 | ||||||||
| FaxNumber: | 5094743245 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2005 | ||||||||
| LastUpdateDate: | 04/16/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | DR-43848 | CO | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 1832 | TN | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | L5248 | TX | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | OP60290492 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.