Provider Demographics
NPI:1821587239
Name:BENJAMIN, JENNIFER CLAUDETTE (APRN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CLAUDETTE
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 WOLCOTT HILL RD
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-1152
Mailing Address - Country:US
Mailing Address - Phone:860-692-7800
Mailing Address - Fax:860-692-7646
Practice Address - Street 1:24 WOLCOTT HILL RD
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-1152
Practice Address - Country:US
Practice Address - Phone:860-692-7800
Practice Address - Fax:860-692-7646
Is Sole Proprietor?:No
Enumeration Date:2018-05-02
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7560363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health