Healthcare Provider Details

I. General information

NPI: 1215169644
Provider Name (Legal Business Name): MARTINA RENATE BENSON CPM, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2009
Last Update Date: 08/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S COOPER ST SUITE 229
MEMPHIS TN
38104-5611
US

IV. Provider business mailing address

1000 S COOPER ST SUITE 229
MEMPHIS TN
38104-5611
US

V. Phone/Fax

Practice location:
  • Phone: 901-275-2907
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN0000167525
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number16
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: