Healthcare Provider Details

I. General information

NPI: 1760707905
Provider Name (Legal Business Name): BONNIE LOUIS BENJAMIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2010
Last Update Date: 03/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 BROADWAY
DENVER CO
80205-2526
US

IV. Provider business mailing address

2100 BROADWAY
DENVER CO
80205-2526
US

V. Phone/Fax

Practice location:
  • Phone: 303-293-2220
  • Fax:
Mailing address:
  • Phone: 303-293-2220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number186134
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: