Provider Demographics
NPI:1922507235
Name:BENNER, MEGAN NICOLE (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:NICOLE
Last Name:BENNER
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 GLOBAL WAY STE 119
Mailing Address - Street 2:
Mailing Address - City:LINTHICUM
Mailing Address - State:MD
Mailing Address - Zip Code:21090-2222
Mailing Address - Country:US
Mailing Address - Phone:667-888-7337
Mailing Address - Fax:410-789-0425
Practice Address - Street 1:605 GLOBAL WAY STE 119
Practice Address - Street 2:
Practice Address - City:LINTHICUM
Practice Address - State:MD
Practice Address - Zip Code:21090-2222
Practice Address - Country:US
Practice Address - Phone:410-789-7337
Practice Address - Fax:410-789-0425
Is Sole Proprietor?:No
Enumeration Date:2018-02-02
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR202351363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD742005600Medicaid