Provider Demographics
NPI:1336524826
Name:BENKOVICH, NATASHA MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:MARIE
Last Name:BENKOVICH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1309
Mailing Address - Street 2:MS 21110Q
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55440-1309
Mailing Address - Country:US
Mailing Address - Phone:651-254-8300
Mailing Address - Fax:651-254-8379
Practice Address - Street 1:640 JACKSON ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2502
Practice Address - Country:US
Practice Address - Phone:651-254-8300
Practice Address - Fax:651-254-8379
Is Sole Proprietor?:No
Enumeration Date:2015-07-25
Last Update Date:2018-11-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL085005527363A00000X
MN12338363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant