Provider Demographics
NPI:1508442740
Name:VON BENKEN, JESSICA ANN (NP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:VON BENKEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 BEL AIR CIR
Mailing Address - Street 2:
Mailing Address - City:MACEDONIA
Mailing Address - State:OH
Mailing Address - Zip Code:44056-1996
Mailing Address - Country:US
Mailing Address - Phone:440-785-9003
Mailing Address - Fax:
Practice Address - Street 1:1313 BEL AIR CIR
Practice Address - Street 2:
Practice Address - City:MACEDONIA
Practice Address - State:OH
Practice Address - Zip Code:44056-1996
Practice Address - Country:US
Practice Address - Phone:440-785-9003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH11200098363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health