Provider Demographics
NPI:1013196112
Name:BENSON, MARY J JODY (RN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:J JODY
Last Name:BENSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 CORRIDA DR
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-5524
Mailing Address - Country:US
Mailing Address - Phone:805-546-0313
Mailing Address - Fax:805-782-9107
Practice Address - Street 1:351 CORRIDA DR
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-5524
Practice Address - Country:US
Practice Address - Phone:805-546-0313
Practice Address - Fax:805-782-9107
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA234315163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health