Provider Demographics
NPI:1760837835
Name:BENSON, MARIE (TATTOO SPECIALIST)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:BENSON
Suffix:
Gender:F
Credentials:TATTOO SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20400 TRAILSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-2146
Mailing Address - Country:US
Mailing Address - Phone:239-728-1234
Mailing Address - Fax:239-949-7737
Practice Address - Street 1:20400 TRAILSIDE DR
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-2146
Practice Address - Country:US
Practice Address - Phone:239-728-1234
Practice Address - Fax:239-949-7737
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1441581056246ZA2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZA2600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherArt, Medical