Provider Demographics
NPI:1619950284
Name:BENSON, JENNIFER (MS CNM)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:BENSON
Suffix:
Gender:F
Credentials:MS CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 1ST ST SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55905-0001
Mailing Address - Country:US
Mailing Address - Phone:507-284-2511
Mailing Address - Fax:312-328-7895
Practice Address - Street 1:5525 S MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1012
Practice Address - Country:US
Practice Address - Phone:773-585-1955
Practice Address - Fax:773-284-5268
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209004580367A00000X
MN485367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID01621679OtherBCBS OF IL
ILQ 18771Medicare UPIN
ID01621679OtherBCBS OF IL