Provider Demographics
NPI:1114448529
Name:STUART, BENJAMIN RUSSEL (DNP, APRN, FNP-C)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:RUSSEL
Last Name:STUART
Suffix:
Gender:M
Credentials:DNP, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2353 E 3225 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-2719
Mailing Address - Country:US
Mailing Address - Phone:435-881-4809
Mailing Address - Fax:
Practice Address - Street 1:330 S CHILOQUIN BLVD
Practice Address - Street 2:
Practice Address - City:CHILOQUIN
Practice Address - State:OR
Practice Address - Zip Code:97624-6747
Practice Address - Country:US
Practice Address - Phone:541-882-1487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5942204-3102163W00000X
CA95035396163W00000X
UT5942204-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse