Healthcare Provider Details

I. General information

NPI: 1639177421
Provider Name (Legal Business Name): SANDRA S. BENKO C.R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 S QUEEN ST
YORK PA
17403-3922
US

IV. Provider business mailing address

1207 S QUEEN ST
YORK PA
17403-3922
US

V. Phone/Fax

Practice location:
  • Phone: 717-846-8869
  • Fax:
Mailing address:
  • Phone: 717-846-8869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP-005931-B
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN-186720-1
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: