MEDICARE: MR. FRANK DOUGLAS BENSON A.P.R.N.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner	200785	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770558850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. FRANK DOUGLAS BENSON A.P.R.N.

Provider Business Mailing Address
First Line	:	77 RIVERVIEW AVE
Second Line	:
City	:	AGAWAM
State	:	MA
Zip	:	01001-2517
Country	:	US
Telephone Number	:	413-786-8442
Fax Number	:

Provider Business Practice Location Address
First Line	:	61 COOPER ST
Second Line	:	HERITAGE HALL WEST
City	:	AGAWAM
State	:	MA
Zip	:	01001-2149
Country	:	US
Telephone Number	:	413-786-8000
Fax Number	:	413-786-5066

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	07/08/2007

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