Provider Demographics
NPI:1356306955
Name:BENSON, SUSAN LEE (DNP, FNP, PMH-CNS)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:LEE
Last Name:BENSON
Suffix:
Gender:F
Credentials:DNP, FNP, PMH-CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7114 CEDARWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-3701
Mailing Address - Country:US
Mailing Address - Phone:303-990-1930
Mailing Address - Fax:
Practice Address - Street 1:7114 CEDARWOOD CIR
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-3701
Practice Address - Country:US
Practice Address - Phone:303-990-1930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2021-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO177793364SP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily