Provider Demographics
NPI:1154393775
Name:BENZ, MARGARET R (APRN-BC)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:R
Last Name:BENZ
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4590 S LINDBERGH BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1810
Mailing Address - Country:US
Mailing Address - Phone:314-849-7669
Mailing Address - Fax:314-849-7670
Practice Address - Street 1:4451 FOREST PARK AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2243
Practice Address - Country:US
Practice Address - Phone:314-289-7537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO078408363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO428583330Medicaid
MO000081536Medicare ID - Type Unspecified
MO428583330Medicaid