Provider Demographics
NPI:1063482933
Name:BENNINGTON, BETH K (WHCNP, CNM)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:K
Last Name:BENNINGTON
Suffix:
Gender:F
Credentials:WHCNP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 POND VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MENDOTA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55120-1925
Mailing Address - Country:US
Mailing Address - Phone:651-415-9563
Mailing Address - Fax:
Practice Address - Street 1:1200 LAGOON AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2077
Practice Address - Country:US
Practice Address - Phone:612-823-6300
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR076808-3363LW0102X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Not Answered367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
HP15878OtherHEALTH PARTNERS
2139398OtherAMERICA'S PPO (ARAZ)
07-03940OtherMEDICA
MN842S5BEOtherBCBS MN
1033360OtherPREFERRED ONE
105724OtherUCARE
36467OtherSIOUX VALLEY HEALTH PLAN