Provider Demographics
NPI:1235431776
Name:BENINGER, ROSEMARIE DIANE (RN)
Entity Type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:DIANE
Last Name:BENINGER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:D
Other - Last Name:BENINGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:16400 NW PANTHER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CARLTON
Mailing Address - State:OR
Mailing Address - Zip Code:97111-9473
Mailing Address - Country:US
Mailing Address - Phone:503-687-1591
Mailing Address - Fax:
Practice Address - Street 1:1309 NE 27TH ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-2305
Practice Address - Country:US
Practice Address - Phone:503-472-4678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200742098RN163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical