Provider Demographics
NPI:1528216801
Name:BENHAM, LORI ELLEN (NP)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ELLEN
Last Name:BENHAM
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 1:1327 CHESTNUT RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-3474
Mailing Address - Country:US
Mailing Address - Phone:281-446-4644
Mailing Address - Fax:281-446-0687
Practice Address - Street 1:18842 S MEMORIAL DR STE 202
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4229
Practice Address - Country:US
Practice Address - Phone:281-446-4644
Practice Address - Fax:281-446-0687
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX553792363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health