Provider Demographics
NPI:1740422971
Name:BENJAMIN, VIRGINIA ANNE (CNA)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:ANNE
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 422
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20757-0422
Mailing Address - Country:US
Mailing Address - Phone:240-744-2724
Mailing Address - Fax:
Practice Address - Street 1:5086 SILVER HILL CT
Practice Address - Street 2:#T2
Practice Address - City:FORESTVILLE
Practice Address - State:MD
Practice Address - Zip Code:20747-2033
Practice Address - Country:US
Practice Address - Phone:240-744-2724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-02
Last Update Date:2009-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNA00602119376K00000X
VA1401097833376K00000X
MDA00060267376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide