Provider Demographics
NPI:1407924822
Name:BENZ, ROSALIE GRIMES (APRN-BC, FNP)
Entity Type:Individual
Prefix:
First Name:ROSALIE
Middle Name:GRIMES
Last Name:BENZ
Suffix:
Gender:F
Credentials:APRN-BC, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 ST. MARY
Mailing Address - Street 2:P. O. BOX 523
Mailing Address - City:PILOT KNOB
Mailing Address - State:MO
Mailing Address - Zip Code:63663-0523
Mailing Address - Country:US
Mailing Address - Phone:573-546-7000
Mailing Address - Fax:573-546-6420
Practice Address - Street 1:200 ST. MARY
Practice Address - Street 2:
Practice Address - City:PILOT KNOB
Practice Address - State:MO
Practice Address - Zip Code:63663
Practice Address - Country:US
Practice Address - Phone:573-546-7000
Practice Address - Fax:573-546-6420
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO090218363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOQ37864Medicare UPIN
MO500670009Medicare PIN
MO824320067Medicare PIN