Provider Demographics
NPI:1932434701
Name:BENSON, GYNDER DIANE (FNP)
Entity Type:Individual
Prefix:
First Name:GYNDER
Middle Name:DIANE
Last Name:BENSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N 11TH ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:71852-4306
Mailing Address - Country:US
Mailing Address - Phone:870-557-7824
Mailing Address - Fax:
Practice Address - Street 1:201 N 11TH ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:AR
Practice Address - Zip Code:71852-4306
Practice Address - Country:US
Practice Address - Phone:870-557-7824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-12
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01641363LF0000X
TX9050363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
0357475OtherANCC