Healthcare Provider Details

I. General information

NPI: 1811519671
Provider Name (Legal Business Name): PHILLINE BENSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2020
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 S QUEBEC ST
CENTENNIAL CO
80112-4411
US

IV. Provider business mailing address

7068 CHESTNUT HILL ST
HIGHLANDS RANCH CO
80130-5106
US

V. Phone/Fax

Practice location:
  • Phone: 858-480-9786
  • Fax:
Mailing address:
  • Phone: 858-480-9786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number654588
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number41881
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1660679
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: