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General NPI Number Information
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NPI Number | 1164074456
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Entity Type | Individual
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Provider Name | ANDRENE BENJAMIN PMHNP, FNP
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Gender | Female
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Dates
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Enumeration Date | 07/16/2019
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Last Update Date | 04/09/2026
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Provider Practice Location Address
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Address Line | 310 SW 4TH AVE UNIT 3-H
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City | PORTLAND
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State | OR
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Zip | 97204-2345
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Country | US
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Telephone | 503-647-6501
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Fax | 503-388-7702
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Provider Business Mailing Address
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Address Line | 306 LINCOLN RD
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City | MIAMI BEACH
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State | FL
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Zip | 33139-3103
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 10031837
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP95011901
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP61632738
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License Number State | WA
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