Provider Demographics
NPI:1619594363
Name:BENSON, SHANNON LESHELL (RN)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:LESHELL
Last Name:BENSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6185 MAGNOLIA AVE # 69
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2524
Mailing Address - Country:US
Mailing Address - Phone:951-333-8127
Mailing Address - Fax:
Practice Address - Street 1:6185 MAGNOLIA AVE # 69
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2524
Practice Address - Country:US
Practice Address - Phone:951-333-8127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA754988163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine