Provider Demographics
NPI:1952637498
Name:BENJAMIN, JANE TAYLOR (CPNP)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:TAYLOR
Last Name:BENJAMIN
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 1:9574 FOLEY BLVD NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-5537
Mailing Address - Country:US
Mailing Address - Phone:763-783-3722
Mailing Address - Fax:763-783-7944
Practice Address - Street 1:9574 FOLEY BLVD NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-5537
Practice Address - Country:US
Practice Address - Phone:763-783-3722
Practice Address - Fax:763-783-7944
Is Sole Proprietor?:No
Enumeration Date:2009-10-18
Last Update Date:2009-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 81484-3363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner