Provider Demographics
NPI:1003827437
Name:BENJAMIN, ELIZABETH L (CRNA)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:L
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 643179
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45264-3179
Mailing Address - Country:US
Mailing Address - Phone:937-293-0247
Mailing Address - Fax:
Practice Address - Street 1:600 WILSON CREEK RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025
Practice Address - Country:US
Practice Address - Phone:812-537-1010
Practice Address - Fax:812-923-3209
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1055243163W00000X
OH085330163W00000X
IN28151384A163W00000X
KY22698367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000556160OtherANTHEM
IN200399670Medicaid
KY74226986Medicaid
IN000000244186OtherANTHEM
OH0752823Medicaid
430077995OtherRAILROAD MEDICARE
KY74226986Medicaid
OH0752823Medicaid