Provider Demographics
NPI:1578990867
Name:BENJAMIN, DELAUNDRIA DENISE (LPN)
Entity Type:Individual
Prefix:
First Name:DELAUNDRIA
Middle Name:DENISE
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14206 WESTROPP AVE
Mailing Address - Street 2:APT. 211
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44110-1975
Mailing Address - Country:US
Mailing Address - Phone:216-301-6471
Mailing Address - Fax:
Practice Address - Street 1:14206 WESTROPP AVE
Practice Address - Street 2:APT. 211
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44110
Practice Address - Country:US
Practice Address - Phone:216-301-6471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-01
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH152736164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse