Provider Demographics
NPI:1982962486
Name:BENSON, MARLEAH LOUISE
Entity Type:Individual
Prefix:
First Name:MARLEAH
Middle Name:LOUISE
Last Name:BENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 GROTON RD APT B
Mailing Address - Street 2:
Mailing Address - City:FREEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13068-9712
Mailing Address - Country:US
Mailing Address - Phone:607-423-0287
Mailing Address - Fax:
Practice Address - Street 1:207 GROTON RD APT B
Practice Address - Street 2:
Practice Address - City:FREEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13068-9712
Practice Address - Country:US
Practice Address - Phone:607-423-0287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY567511-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse