Provider Demographics
NPI:1821841925
Name:BENDER, ELIZA MAE (STUDENT)
Entity Type:Individual
Prefix:
First Name:ELIZA
Middle Name:MAE
Last Name:BENDER
Suffix:
Gender:F
Credentials:STUDENT
Other - Prefix:
Other - First Name:ELIZA
Other - Middle Name:MAE
Other - Last Name:GRIGGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1430 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-2709
Mailing Address - Country:US
Mailing Address - Phone:920-285-8922
Mailing Address - Fax:
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-356-1616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program