Provider Demographics
NPI:1174863096
Name:BENJAMIN, ZELLA DANNELL (RN)
Entity Type:Individual
Prefix:
First Name:ZELLA
Middle Name:DANNELL
Last Name:BENJAMIN
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 1:701 LEWELLEN AVE
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550-5235
Mailing Address - Country:US
Mailing Address - Phone:843-857-3790
Mailing Address - Fax:843-857-3715
Practice Address - Street 1:701 LEWELLEN AVE
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-5235
Practice Address - Country:US
Practice Address - Phone:843-857-3790
Practice Address - Fax:843-857-3715
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-01
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC40761163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse