Provider Demographics
NPI:1083998678
Name:ANDERSON, BENETTA S (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:BENETTA
Middle Name:S
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 WALL ST
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-2857
Mailing Address - Country:US
Mailing Address - Phone:732-452-1776
Mailing Address - Fax:
Practice Address - Street 1:81 WALL ST
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-2857
Practice Address - Country:US
Practice Address - Phone:732-452-1776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26N012455200363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health