Healthcare Provider Details

I. General information

NPI: 1588304455
Provider Name (Legal Business Name): JAMIE LYNN BENUSA APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAMIE LYNN JENKINS

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 03/30/2022
Certification Date: 03/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2530 CHICAGO AVE STE 500
MINNEAPOLIS MN
55404-4291
US

IV. Provider business mailing address

3680 INDEPENDENCE AVE S APT 82
ST LOUIS PARK MN
55426-3760
US

V. Phone/Fax

Practice location:
  • Phone: 612-813-8800
  • Fax:
Mailing address:
  • Phone: 952-270-5054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number8772
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: