Provider Demographics
NPI:1689940785
Name:BENTON, ARYN RAE (RN)
Entity Type:Individual
Prefix:MRS
First Name:ARYN
Middle Name:RAE
Last Name:BENTON
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 1:1209 SITKA ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-2020
Mailing Address - Country:US
Mailing Address - Phone:303-345-7991
Mailing Address - Fax:
Practice Address - Street 1:1209 SITKA ST UNIT 2
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-2020
Practice Address - Country:US
Practice Address - Phone:303-345-7991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR041201163W00000X
CO178915163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse