Provider Demographics
NPI:1679901862
Name:BENFIELD, CHERYL L (RN)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:L
Last Name:BENFIELD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2853 CR 3900
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KS
Mailing Address - Zip Code:67301-7595
Mailing Address - Country:US
Mailing Address - Phone:620-331-9070
Mailing Address - Fax:620-331-9070
Practice Address - Street 1:2853 CR 3900
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KS
Practice Address - Zip Code:67301-7595
Practice Address - Country:US
Practice Address - Phone:620-331-9070
Practice Address - Fax:620-331-9070
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-24
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-44466-101163W00000X
KS200713460A251C00000X, 311ZA0620X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No163W00000XNursing Service ProvidersRegistered Nurse
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200713460AOtherKANAS DEPARTMENT FOR AGING AND DISABILITY SERVICES
KS200713460AOtherKANAS DEPARTMENT FOR AGING AND DISABILITY SERVICES