Provider Demographics
NPI:1720581770
Name:BENJAMIN, LUNISE (NP)
Entity Type:Individual
Prefix:
First Name:LUNISE
Middle Name:
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 WHITE OAK ST
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-4710
Mailing Address - Country:US
Mailing Address - Phone:336-483-3001
Mailing Address - Fax:
Practice Address - Street 1:51 MOSAIC BLVD STE 100
Practice Address - Street 2:
Practice Address - City:PITTSBORO
Practice Address - State:NC
Practice Address - Zip Code:27312-4945
Practice Address - Country:US
Practice Address - Phone:984-215-6766
Practice Address - Fax:984-215-6768
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5010361363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner