Provider Demographics
NPI:1184454480
Name:BENJAMIN, STEPHANIE MAE (LPN)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MAE
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:MAE
Other - Last Name:ARMSTRONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4131 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:SALAMANCA
Mailing Address - State:NY
Mailing Address - Zip Code:14779-9779
Mailing Address - Country:US
Mailing Address - Phone:716-265-1896
Mailing Address - Fax:
Practice Address - Street 1:4131 N STATE ST
Practice Address - Street 2:
Practice Address - City:SALAMANCA
Practice Address - State:NY
Practice Address - Zip Code:14779-9779
Practice Address - Country:US
Practice Address - Phone:716-265-1896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY350824164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse