Provider Demographics
NPI:1689271751
Name:BENJAMIN, LORPU GBORKORQUELLIE (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:LORPU
Middle Name:GBORKORQUELLIE
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3426 AYLESFORD LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46228-2880
Mailing Address - Country:US
Mailing Address - Phone:317-293-1104
Mailing Address - Fax:
Practice Address - Street 1:3426 AYLESFORD LN
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46228-2880
Practice Address - Country:US
Practice Address - Phone:317-293-1104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28187669A163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical