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1164074456 NPI number — ANDRENE BENJAMIN PMHNP, FNP

NPI Number: 1164074456
Health Care Provider/Practitioner: ANDRENE BENJAMIN PMHNP, FNP

Information about “1164074456” NPI (ANDRENE BENJAMIN PMHNP, FNP) exists in 1164074456 in HTML format HTML  |  1164074456 in plain Text format TXT  |  1164074456 in PDF (Portable Document Format) PDF  |  1164074456 in an XML format XML  formats.

NPI Number : 1164074456 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1164074456",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BENJAMIN",
    "FirstName": "ANDRENE",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PMHNP, FNP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "306 LINCOLN RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MIAMI BEACH",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33139-3103",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "310 SW 4TH AVE UNIT 3-H",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PORTLAND",
    "PracticeLocationAddressStateName": "OR",
    "PracticeLocationAddressPostalCode": "97204-2345",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "503-647-6501",
    "PracticeLocationAddressFaxNumber": "503-388-7702",
    "EnumerationDate": "07/16/2019",
    "LastUpdateDate": "04/09/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "363LP0808X",
          "TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
          "LicenseNumber": "10031837",
          "LicenseNumberStateCode": "OR",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "NP95011901",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LP0808X",
          "TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
          "LicenseNumber": "AP61632738",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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