Provider Demographics
NPI:1255764734
Name:BENBROOK, CHEILSA DAWN (APRN)
Entity type:Individual
Prefix:MRS
First Name:CHEILSA
Middle Name:DAWN
Last Name:BENBROOK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CHEILSA
Other - Middle Name:DAWN
Other - Last Name:WIESNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1709 N NICKELTON CIR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67235-1546
Mailing Address - Country:US
Mailing Address - Phone:316-641-5871
Mailing Address - Fax:
Practice Address - Street 1:110 N 66TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-2402
Practice Address - Country:US
Practice Address - Phone:402-325-8570
Practice Address - Fax:402-991-9052
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS76108363LF0000X
NE115170363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily