Provider Demographics
NPI:1295767994
Name:BENSON, PAULETTE (FNP PAC)
Entity type:Individual
Prefix:
First Name:PAULETTE
Middle Name:
Last Name:BENSON
Suffix:
Gender:F
Credentials:FNP PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 4TH AVE S
Mailing Address - Street 2:PO BOX 647
Mailing Address - City:WISHEK
Mailing Address - State:ND
Mailing Address - Zip Code:58495-7527
Mailing Address - Country:US
Mailing Address - Phone:701-452-2364
Mailing Address - Fax:701-452-4276
Practice Address - Street 1:1007 4TH AVE S
Practice Address - Street 2:
Practice Address - City:WISHEK
Practice Address - State:ND
Practice Address - Zip Code:58495-7527
Practice Address - Country:US
Practice Address - Phone:701-452-2364
Practice Address - Fax:701-452-4276
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPAC0005363A00000X
NDR19454363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND5063Medicaid
ND1008354OtherPREFERRED ONE
ND13337OtherBSND GACKLE
ND13368OtherBSND NAPOLEON
ND4653OtherBSND WISHEK
ND970001331OtherRR MEDICARE
ND5085Medicaid
ND19905Medicaid
ND5028Medicaid
ND5166Medicaid
ND0118469OtherMEDICA NAPOLEON
ND0118448OtherMEDICA KULM
ND26311OtherBSND KULM
ND0118069OtherMEDICA WISHEK
ND0118504OtherMEDICA GACKLE
ND0118504OtherMEDICA GACKLE
ND1008354OtherPREFERRED ONE
ND353411Medicare ID - Type Unspecified@ KULM
ND19905Medicaid
ND5085Medicaid
ND5028Medicaid