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General NPI Number Information
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NPI Number | 1417287293
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Entity Type | Individual
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Provider Name | TOSHA MARLENE BENSON LMP
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Gender | Female
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Dates
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Enumeration Date | 12/30/2009
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Last Update Date | 12/30/2009
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Provider Practice Location Address
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Address Line | 14201 NE 20TH AVE SUITE 3101
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City | VANCOUVER
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State | WA
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Zip | 98686-6410
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Country | US
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Telephone | 360-576-8599
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Fax | 360-576-6320
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Provider Business Mailing Address
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Address Line | 9600 NE 132ND AVE
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City | VANCOUVER
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State | WA
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Zip | 98682-2912
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Country | US
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Telephone | 360-518-8614
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | MA00024793
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License Number State | WA
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