Provider Demographics
NPI:1013330737
Name:BENJAMIN, LAURIE-ANN
Entity Type:Individual
Prefix:MRS
First Name:LAURIE-ANN
Middle Name:
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 S. COLUMBUS AVE
Mailing Address - Street 2:APT. 03
Mailing Address - City:MT. VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10553
Mailing Address - Country:US
Mailing Address - Phone:914-230-9371
Mailing Address - Fax:
Practice Address - Street 1:203 S. COLUMBUS AVE
Practice Address - Street 2:APT. 03
Practice Address - City:MT. VERNON
Practice Address - State:NY
Practice Address - Zip Code:10553
Practice Address - Country:US
Practice Address - Phone:914-230-9371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-31
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY316905163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse