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General NPI Number Information
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NPI Number | 1184500902
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Entity Type | Individual
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Provider Name | BENJAMIN JASPER RN
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Gender | Male
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Dates
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Enumeration Date | 08/15/2025
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Last Update Date | 08/15/2025
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Provider Practice Location Address
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Address Line | 3333 GREEN BAY RD
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City | NORTH CHICAGO
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State | IL
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Zip | 60064-3037
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Country | US
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Telephone | 847-578-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 817 RIDDLEWOOD LN
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City | HIGHLANDS RANCH
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State | CO
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Zip | 80129-6987
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Country | US
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Telephone | 319-269-5684
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 041.590880
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 1663681
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License Number State | CO
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