Provider Demographics
NPI:1376949123
Name:BENJAMIN, MONICA
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:BENJAMIN
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 1:44 COLLINS DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753-8502
Mailing Address - Country:US
Mailing Address - Phone:802-388-1338
Mailing Address - Fax:802-388-8244
Practice Address - Street 1:44 COLLINS DR
Practice Address - Street 2:SUITE 202
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-8502
Practice Address - Country:US
Practice Address - Phone:802-388-1338
Practice Address - Fax:802-388-8244
Is Sole Proprietor?:No
Enumeration Date:2014-11-06
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0110517363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily