Healthcare Provider Details

I. General information

NPI: 1205569316
Provider Name (Legal Business Name): MICHELLE BENSON CN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2022
Last Update Date: 07/06/2022
Certification Date: 06/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2116 CATON WAY SW STE 102
OLYMPIA WA
98502-1176
US

IV. Provider business mailing address

5501 17TH AVE NE
OLYMPIA WA
98516-3806
US

V. Phone/Fax

Practice location:
  • Phone: 360-915-2151
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberNU61327590
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberNU61327590
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: