Healthcare Provider Details

I. General information

NPI: 1134528946
Provider Name (Legal Business Name): LYNNE BENJAMIN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LYNN JOPECK APRN

II. Dates (important events)

Enumeration Date: 08/18/2014
Last Update Date: 06/24/2021
Certification Date: 06/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 DALE RD
AVON CT
06001-4315
US

IV. Provider business mailing address

30 JORDAN LN
WETHERSFIELD CT
06109-1278
US

V. Phone/Fax

Practice location:
  • Phone: 860-674-8830
  • Fax:
Mailing address:
  • Phone: 860-263-0253
  • Fax: 860-263-0262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5854
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: