Provider Demographics
NPI:1679267991
Name:BENZ, CHARMAGNE JOY (FNP)
Entity Type:Individual
Prefix:MRS
First Name:CHARMAGNE
Middle Name:JOY
Last Name:BENZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 N VIRGINIA ST STE 101
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-4125
Mailing Address - Country:US
Mailing Address - Phone:815-271-7300
Mailing Address - Fax:815-893-0448
Practice Address - Street 1:31 N VIRGINIA ST STE 101
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-4125
Practice Address - Country:US
Practice Address - Phone:815-271-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209027548363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily