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NPI Code Detail

MEDICARE: MRS. JENNIFER KOOIKER BENSON MD

MEDICARE: MRS. JENNIFER KOOIKER BENSON MD
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
1207Q00000XFamily Medicine PhysicianMD00037772WA

General Provider Information

NPI Number : 1801899182
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JENNIFER KOOIKER BENSON MD
Provider Business Mailing Address
First Line : 1400 E KINCAID ST
Second Line :
City : MOUNT VERNON
State : WA
Zip : 98274-4127
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 110 N LAVENTURE RD STE C
Second Line :
City : MOUNT VERNON
State : WA
Zip : 98273-3901
Country : US
Telephone Number : 360-399-7700
Fax Number : 360-899-4534
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2005
Last Update Date : 10/25/2021

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