Provider Demographics
NPI:1336386119
Name:BENANZER, ERIN M (NP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:M
Last Name:BENANZER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:M
Other - Last Name:SIEBENECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 7527
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-0727
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7450 HOSPITAL DR STE 290
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-9641
Practice Address - Country:US
Practice Address - Phone:614-566-8883
Practice Address - Fax:614-566-8149
Is Sole Proprietor?:No
Enumeration Date:2009-01-15
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.18317363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0156608Medicaid
OHH352411Medicare PIN
IL0533210001Medicare NSC
OH0156608Medicaid
ILIL3270241Medicare PIN
IL407270011Medicare PIN