Provider Demographics
NPI:1245435742
Name:KIBLER, BENJAMIN ROBERT (LPN)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:ROBERT
Last Name:KIBLER
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 W. LA JOLLA DR.
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-4613
Mailing Address - Country:US
Mailing Address - Phone:330-327-1633
Mailing Address - Fax:
Practice Address - Street 1:1050 W LA JOLLA DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-4613
Practice Address - Country:US
Practice Address - Phone:330-327-1633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN152227163W00000X
OHPN105012164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse