Healthcare Provider Details

I. General information

NPI: 1124615869
Provider Name (Legal Business Name): SUSAN MARGARET BENJAMIN-MLYNARCZUK MSN, RN, NPD-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2020
Last Update Date: 12/29/2020
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1134 MILDRED AVE
ANDALUSIA PA
19020-6432
US

IV. Provider business mailing address

1134 MILDRED AVE
ANDALUSIA PA
19020-6432
US

V. Phone/Fax

Practice location:
  • Phone: 215-244-9669
  • Fax:
Mailing address:
  • Phone: 215-526-7525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN258994L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: