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General NPI Number Information
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NPI Number | 1922796077
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Entity Type | Individual
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Provider Name | LESA JOY BENTON NP
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Gender | Female
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Dates
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Enumeration Date | 04/26/2023
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Last Update Date | 12/11/2023
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Provider Practice Location Address
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Address Line | 7477 SE 52ND AVE
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City | PORTLAND
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State | OR
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Zip | 97206-8206
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Country | US
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Telephone | 503-572-4196
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Fax |
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Provider Business Mailing Address
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Address Line | 7477 SE 52ND AVE
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City | PORTLAND
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State | OR
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Zip | 97206-8206
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Country | US
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Telephone | 503-572-4196
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | AP61415533
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | AP61415533
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 10007097
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License Number State | OR
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