Provider Demographics
NPI:1538479761
Name:BENSON, SERENA GAIL (NAC)
Entity Type:Individual
Prefix:MS
First Name:SERENA
Middle Name:GAIL
Last Name:BENSON
Suffix:
Gender:F
Credentials:NAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 PRINCETON AVE N
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-1879
Mailing Address - Country:US
Mailing Address - Phone:509-433-2215
Mailing Address - Fax:
Practice Address - Street 1:521 PRINCETON AVE N
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-1879
Practice Address - Country:US
Practice Address - Phone:509-433-2215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANC 60027206374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
WANC 60027206OtherDEPARTMENT OF HEALTH