Healthcare Provider Details

I. General information

NPI: 1770558850
Provider Name (Legal Business Name): FRANK DOUGLAS BENSON A.P.R.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 COOPER ST HERITAGE HALL WEST
AGAWAM MA
01001-2149
US

IV. Provider business mailing address

77 RIVERVIEW AVE
AGAWAM MA
01001-2517
US

V. Phone/Fax

Practice location:
  • Phone: 413-786-8000
  • Fax: 413-786-5066
Mailing address:
  • Phone: 413-786-8442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number200785
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: