Basic Information
Provider Information
NPI: 1154676567
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BENSON
FirstName: DARLA
MiddleName: DENISE
NamePrefix: MRS.
NameSuffix:  
Credential: ANP - C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 30 W RAMPART ST STE 200
Address2:  
City: SHELBYVILLE
State: IN
PostalCode: 461768846
CountryCode: US
TelephoneNumber: 3174212012
FaxNumber: 3173981851
Practice Location
Address1: 2451 INTELLIPLEX DR STE 260
Address2:  
City: SHELBYVILLE
State: IN
PostalCode: 461768580
CountryCode: US
TelephoneNumber: 3173980121
FaxNumber: 3173980538
Other Information
ProviderEnumerationDate: 07/23/2012
LastUpdateDate: 09/10/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/10/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LA2200X71004035AINY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health

No ID Information.


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