Provider Demographics
NPI:1922776863
Name:BENSON, WILLIAM VON JR
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:VON
Last Name:BENSON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3830 YORKLAND DR NW APT 12
Mailing Address - Street 2:
Mailing Address - City:COMSTOCK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:49321-8853
Mailing Address - Country:US
Mailing Address - Phone:616-984-0863
Mailing Address - Fax:
Practice Address - Street 1:3830 YORKLAND DR NW APT 12
Practice Address - Street 2:
Practice Address - City:COMSTOCK PARK
Practice Address - State:MI
Practice Address - Zip Code:49321-8853
Practice Address - Country:US
Practice Address - Phone:616-984-0863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-03
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant