MEDICARE: JESSICA LEEANN BENJAMIN

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	251T00000X	PACE Provider Organization	00016261488072701238	NV

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	:	1881308393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LEEANN BENJAMIN

Provider Business Mailing Address
First Line	:	2525 DONNA ST APT D
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-5571
Country	:	US
Telephone Number	:	909-991-9464
Fax Number	:

Provider Business Practice Location Address
First Line	:	2525 DONNA ST APT D
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-5571
Country	:	US
Telephone Number	:	909-991-9464
Fax Number	:

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

Provider Enumeration Date	:	01/09/2023
Last Update Date	:	01/09/2023

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