Provider Demographics
NPI:1598540106
Name:BENJAMIN, KISI YAVECIA
Entity Type:Individual
Prefix:
First Name:KISI
Middle Name:YAVECIA
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3332 8TH ST NE
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58703-2610
Mailing Address - Country:US
Mailing Address - Phone:701-770-0886
Mailing Address - Fax:
Practice Address - Street 1:3332 8TH ST NE
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58703-2610
Practice Address - Country:US
Practice Address - Phone:701-770-0886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor