Basic Information
| Provider Information | |||||||||
| NPI: | 1861058455 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAWALT | ||||||||
| FirstName: | BENJAMIN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2114 N 1000TH RD | ||||||||
| Address2: | |||||||||
| City: | EUDORA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660259193 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3085202591 | ||||||||
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| Practice Location | |||||||||
| Address1: | 600 SW 6TH AVE | ||||||||
| Address2: | |||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666033362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852339643 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2019 | ||||||||
| LastUpdateDate: | 07/02/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | 78860 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 163W00000X | 141628 | KS | N | Nursing Service Providers | Registered Nurse |
No ID Information.