Healthcare Provider Details

I. General information

NPI: 1265861785
Provider Name (Legal Business Name): MELANIE BENSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2013
Last Update Date: 11/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 E HIGHLAND AVE SUITE 300
PHOENIX AZ
85016-4872
US

IV. Provider business mailing address

2222 E HIGHLAND AVE SUITE 300
PHOENIX AZ
85016-4872
US

V. Phone/Fax

Practice location:
  • Phone: 602-277-6211
  • Fax: 866-242-5309
Mailing address:
  • Phone: 602-277-6211
  • Fax: 866-242-5309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number00000
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: