1902156524 NPI number — ERIKA BROSLAT BENFIELD FNP-C

Table of content: ERIKA BROSLAT BENFIELD FNP-C (NPI 1902156524)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902156524 NPI number — ERIKA BROSLAT BENFIELD FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENFIELD
Provider First Name:
ERIKA
Provider Middle Name:
BROSLAT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BROSLAT
Provider Other First Name:
ERIKA
Provider Other Middle Name:
DAWN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1902156524
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 W WINDCREST ST
Provider Second Line Business Mailing Address:
CORNERSTONE CLINIC
Provider Business Mailing Address City Name:
FREDERICKSBURG
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78624-4481
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-997-0330
Provider Business Mailing Address Fax Number:
830-997-7601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 W WINDCREST ST
Provider Second Line Business Practice Location Address:
CORNERSTONE CLINIC
Provider Business Practice Location Address City Name:
FREDERICKSBURG
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78624-4481
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-997-0330
Provider Business Practice Location Address Fax Number:
830-997-7601
Provider Enumeration Date:
09/11/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  779618 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 885N62 . This is a "BCBSTX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 310837501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01108626 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com