Individual
DR. BENJAMIN RIEBESEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5734 COVENTRY LN, FORT WAYNE, IN 46804-7141
(260) 435-7973
Mailing address
12063 LOWER HUNTINGTON RD, ROANOKE, IN 46783-9667
(251) 599-6756
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28232032A
IN
367500000X
Certified Registered Nurse Anesthetist
Primary
28232032A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300019421
—
IN
01
—
412840169
MEDICARE
IN
05
—
7100910520
—
KY
Enumeration date
11/09/2016
Last updated
03/11/2024
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