Healthcare Provider Details

I. General information

NPI: 1306680236
Provider Name (Legal Business Name): MWAMINI BENGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2024
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8005 CREST ACRES DR
MASON OH
45040-9613
US

IV. Provider business mailing address

8005 CREST ACRES DR
MASON OH
45040-9613
US

V. Phone/Fax

Practice location:
  • Phone: 513-515-8815
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0039486
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: