Provider Demographics
NPI:1093415804
Name:BENNER, TONYA L (RN)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:L
Last Name:BENNER
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 1:7136 W 2ND PL
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-8525
Mailing Address - Country:US
Mailing Address - Phone:509-961-1028
Mailing Address - Fax:
Practice Address - Street 1:7136 W 2ND PL
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-8525
Practice Address - Country:US
Practice Address - Phone:509-961-1028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00135998163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse