Basic Information
| Provider Information | |||||||||
| NPI: | 1750987921 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DORENKAMP | ||||||||
| FirstName: | BENJAMIN | ||||||||
| MiddleName: | EUGENE | ||||||||
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| Credential: | FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2206 ERIK LN | ||||||||
| Address2: | |||||||||
| City: | PACIFIC | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630692656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149745562 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1000 E CHERRY ST | ||||||||
| Address2: | |||||||||
| City: | TROY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633791513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6365288551 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2020 | ||||||||
| LastUpdateDate: | 12/11/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 2020016745 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.