Healthcare Provider Details

I. General information

NPI: 1790636025
Provider Name (Legal Business Name): CORDAYSIA JANAY BENSON LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 LASALLE ST
CHARLOTTE NC
28216-4640
US

IV. Provider business mailing address

2020 LASALLE ST
CHARLOTTE NC
28216-4640
US

V. Phone/Fax

Practice location:
  • Phone: 234-349-0330
  • Fax:
Mailing address:
  • Phone: 234-349-0330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number191468
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: