Provider Demographics
NPI:1578138459
Name:BENSON, SARA (RN, PHN)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:BENSON
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 S 5TH ST STE 119H
Mailing Address - Street 2:
Mailing Address - City:OLIVIA
Mailing Address - State:MN
Mailing Address - Zip Code:56277-1375
Mailing Address - Country:US
Mailing Address - Phone:320-523-2570
Mailing Address - Fax:320-523-3749
Practice Address - Street 1:105 S 5TH ST STE 119H
Practice Address - Street 2:
Practice Address - City:OLIVIA
Practice Address - State:MN
Practice Address - Zip Code:56277-1375
Practice Address - Country:US
Practice Address - Phone:320-523-2570
Practice Address - Fax:320-523-3749
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1894532163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator