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General NPI Number Information
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NPI Number | 1528216801
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Entity Type | Individual
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Provider Name | LORI ELLEN BENHAM N.P.
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Gender | Female
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Dates
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Enumeration Date | 08/28/2008
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Last Update Date | 08/28/2008
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Provider Practice Location Address
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Address Line | 18842 S MEMORIAL DR STE 202
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City | HUMBLE
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State | TX
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Zip | 77338-4229
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Country | US
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Telephone | 281-446-4644
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Fax | 281-446-0687
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Provider Business Mailing Address
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Address Line | 1327 CHESTNUT RIDGE RD
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City | KINGWOOD
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State | TX
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Zip | 77339-3474
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Country | US
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Telephone | 281-446-4644
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Fax | 281-446-0687
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 553792
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License Number State | TX
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