Provider Demographics
NPI:1124394952
Name:BENTON, LAURA F
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:F
Last Name:BENTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13640 STEELECROFT PKWY
Mailing Address - Street 2:210
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-7796
Mailing Address - Country:US
Mailing Address - Phone:704-512-6100
Mailing Address - Fax:704-587-7601
Practice Address - Street 1:13640 STEELECROFT PKWY
Practice Address - Street 2:210
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28278-7796
Practice Address - Country:US
Practice Address - Phone:704-512-6100
Practice Address - Fax:704-587-7601
Is Sole Proprietor?:No
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10813644174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN