Provider Demographics
NPI:1669638839
Name:BENNION, NAOMI JO (LPN)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:JO
Last Name:BENNION
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 1:9719 COUNTY ROAD 15
Mailing Address - Street 2:
Mailing Address - City:FILLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14735-8760
Mailing Address - Country:US
Mailing Address - Phone:585-567-8315
Mailing Address - Fax:
Practice Address - Street 1:10908 ROUTE 19
Practice Address - Street 2:
Practice Address - City:FILLMORE
Practice Address - State:NY
Practice Address - Zip Code:14735
Practice Address - Country:US
Practice Address - Phone:585-567-8296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY293867164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse