Provider Demographics
NPI:1497172555
Name:BENSON, CHRISTINA HENINGER (PA)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:HENINGER
Last Name:BENSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 E GOLDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-452-8000
Mailing Address - Fax:208-452-8055
Practice Address - Street 1:910 NW 16TH ST STE 101
Practice Address - Street 2:
Practice Address - City:FRUITLAND
Practice Address - State:ID
Practice Address - Zip Code:83619-2265
Practice Address - Country:US
Practice Address - Phone:208-452-8000
Practice Address - Fax:208-452-8055
Is Sole Proprietor?:No
Enumeration Date:2014-03-26
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA181966363A00000X
IDPA-1156363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant