Provider Demographics
NPI:1013260181
Name:BENJAMIN, SHARON LOUISE (ANP)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:LOUISE
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2724 HARVEST CT
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116
Mailing Address - Country:US
Mailing Address - Phone:541-292-0434
Mailing Address - Fax:503-941-5114
Practice Address - Street 1:2724 HARVEST CT
Practice Address - Street 2:
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116
Practice Address - Country:US
Practice Address - Phone:541-292-0434
Practice Address - Fax:503-941-5114
Is Sole Proprietor?:No
Enumeration Date:2012-10-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201150159363LA2200X
OR201150159NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500653197Medicaid
ORMB2531970OtherDEA