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General NPI Number Information
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NPI Number | 1568911865
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Entity Type | Individual
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Provider Name | SHANNON MICHELLE BENJAMIN RN,WCC
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Gender | Female
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Dates
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Enumeration Date | 09/27/2016
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Last Update Date | 10/03/2016
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Provider Practice Location Address
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Address Line | 2519 PALMETO DR
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City | NEW IBERIA
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State | LA
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Zip | 70563-2926
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Country | US
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Telephone | 337-680-0001
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Fax |
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Provider Business Mailing Address
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Address Line | 206 E GLENHILL BLVD
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City | LAFAYETTE
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State | LA
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Zip | 70501-1394
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Country | US
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Telephone | 337-680-0001
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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 | RN141609
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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License Number | 4260923
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License Number State | LA
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