Healthcare Provider Details

I. General information

NPI: 1104720630
Provider Name (Legal Business Name): ELIZABETH BENNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 EDGAR ST STE A
YORK PA
17403-2862
US

IV. Provider business mailing address

680 S PLEASANT AVE
DALLASTOWN PA
17313-9237
US

V. Phone/Fax

Practice location:
  • Phone: 717-851-1500
  • Fax:
Mailing address:
  • Phone: 171-851-1500
  • Fax: 717-851-1515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN762510
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: