Provider Demographics
NPI:1699063867
Name:BENISH, SARA L (LPN)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:L
Last Name:BENISH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 E ANDERSON ST
Mailing Address - Street 2:
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-3768
Mailing Address - Country:US
Mailing Address - Phone:715-362-9214
Mailing Address - Fax:
Practice Address - Street 1:130 E ANDERSON ST
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-3768
Practice Address - Country:US
Practice Address - Phone:715-362-9214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI311615164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse