Provider Demographics
NPI:1629460100
Name:BENJAMIN, DAVID (FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:BENJAMIN
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3378 FASHION SQUARE BLVD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-2448
Mailing Address - Country:US
Mailing Address - Phone:989-272-7610
Mailing Address - Fax:989-249-0212
Practice Address - Street 1:3378 FASHION SQUARE BLVD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-2448
Practice Address - Country:US
Practice Address - Phone:989-272-7610
Practice Address - Fax:989-249-0212
Is Sole Proprietor?:No
Enumeration Date:2015-02-20
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704206645363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily