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General NPI Number Information
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NPI Number | 1578850558
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Entity Type | Individual
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Provider Name | ANN ELIZABETH BENNER PNP
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Gender | Female
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Dates
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Enumeration Date | 06/29/2011
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Last Update Date | 11/25/2025
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Provider Practice Location Address
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Address Line | 80 E MAIN ST
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City | CANTON
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State | NY
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Zip | 13617-1450
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Country | US
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Telephone | 315-261-5615
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Fax | 315-261-7183
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Provider Business Mailing Address
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Address Line | 50 LEROY ST
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City | POTSDAM
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State | NY
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Zip | 13676-1799
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Country | US
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Telephone | 315-265-3300
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Fax | 315-261-6025
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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 | 163WS0200X
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Taxonomy Name | School Registered Nurse
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License Number | 22570374
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 382969
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 22570374
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License Number State | NY
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