Provider Demographics
NPI:1699199224
Name:BENTON, NICHOLE (RN)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
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 1:1902 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:MILES CITY
Mailing Address - State:MT
Mailing Address - Zip Code:59301-4622
Mailing Address - Country:US
Mailing Address - Phone:406-852-0111
Mailing Address - Fax:
Practice Address - Street 1:210 S WINCHESTER AVE
Practice Address - Street 2:
Practice Address - City:MILES CITY
Practice Address - State:MT
Practice Address - Zip Code:59301-4757
Practice Address - Country:US
Practice Address - Phone:406-874-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT48196163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse