Active NPI
Nicholas Wayne Benner
- Behavior Technician
- Waite Park, MN
National Provider Identifier
1922719780
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 314 10TH Ave S # 100
Waite Park, MN 56387-1400 - Phone
- (615) 767-7222
- NPI assigned
- Dec 12, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Primary |
Addresses
Primary practice location
314 10TH Ave S # 100
Waite Park, MN 56387-1400
Mailing address
745 14TH Ave S
Saint Cloud, MN 56301-4147
Phone (320) 761-5215
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1670803200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1670803200000",
"number": "1922719780",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "745 14TH AVE S",
"city": "SAINT CLOUD",
"state": "MN",
"postal_code": "563014147",
"telephone_number": "320-761-5215"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "314 10TH AVE S # 100",
"city": "WAITE PARK",
"state": "MN",
"postal_code": "563871400",
"telephone_number": "615-767-7222"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENNER",
"first_name": "NICHOLAS",
"middle_name": "WAYNE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-12-12",
"last_updated": "2022-12-12",
"certification_date": "2022-12-12",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waite Park, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.