Provider Demographics
NPI:1528470655
Name:HART, BENJAMIN (CNM)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:HART
Suffix:
Gender:M
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E 1ST ST STE LL
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-2297
Mailing Address - Country:US
Mailing Address - Phone:218-249-4700
Mailing Address - Fax:218-722-5148
Practice Address - Street 1:1000 E 1ST ST STE LL
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805
Practice Address - Country:US
Practice Address - Phone:218-249-4700
Practice Address - Fax:218-722-5148
Is Sole Proprietor?:No
Enumeration Date:2014-05-23
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN623978163W00000X
PAMW010341367A00000X
MN368367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse