Healthcare Provider Details

I. General information

NPI: 1487933545
Provider Name (Legal Business Name): LISA MARIE BENTON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2011
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 S 40TH AVE STE C
YAKIMA WA
98908-3800
US

IV. Provider business mailing address

1020 S 40TH AVE STE C
YAKIMA WA
98908-3800
US

V. Phone/Fax

Practice location:
  • Phone: 509-223-9112
  • Fax:
Mailing address:
  • Phone: 509-223-9112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number22728
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number15974
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60230744
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: