Provider Demographics
NPI:1245532480
Name:BENZ, ALEXANDRA WILSON (APN, CPNP)
Entity type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:WILSON
Last Name:BENZ
Suffix:
Gender:F
Credentials:APN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 E CHICAGO AVE # 93
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2991
Mailing Address - Country:US
Mailing Address - Phone:312-227-6352
Mailing Address - Fax:312-227-9408
Practice Address - Street 1:225 E CHICAGO AVE # 93
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2991
Practice Address - Country:US
Practice Address - Phone:312-227-6352
Practice Address - Fax:312-227-9408
Is Sole Proprietor?:No
Enumeration Date:2010-11-20
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209008493363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics