Healthcare Provider Details

I. General information

NPI: 1568051555
Provider Name (Legal Business Name): NICOLE L BENJAMIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2021
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 ANNIES WAY
SPRINGFIELD MA
01119-1483
US

IV. Provider business mailing address

14 ANNIES WAY
SPRINGFIELD MA
01119-1483
US

V. Phone/Fax

Practice location:
  • Phone: 413-386-7997
  • Fax:
Mailing address:
  • Phone: 413-386-7997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN2301802
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: