Provider Demographics
NPI:1881140515
Name:BENNER, GINGER KAY
Entity type:Individual
Prefix:
First Name:GINGER
Middle Name:KAY
Last Name:BENNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GINGER
Other - Middle Name:KAY
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:321 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48875-1147
Mailing Address - Country:US
Mailing Address - Phone:517-526-4826
Mailing Address - Fax:
Practice Address - Street 1:321 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:MI
Practice Address - Zip Code:48875-1147
Practice Address - Country:US
Practice Address - Phone:517-526-4826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other