Provider Demographics
NPI:1679367668
Name:BENJAMIN, CHANTA (BSN, RN)
Entity type:Individual
Prefix:
First Name:CHANTA
Middle Name:
Last Name:BENJAMIN
Suffix:
Gender:
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 THOROUGHBRED DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-5320
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:23 THOROUGHBRED DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-5320
Practice Address - Country:US
Practice Address - Phone:757-344-9789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001271735163WC1600X, 163WG0600X, 163W00000X, 163WA2000X
174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No163WG0600XNursing Service ProvidersRegistered NurseGerontology
No174H00000XOther Service ProvidersHealth Educator
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator