MEDICARE: MRS. SUZANNE F BENJAMIN FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN035803	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093765489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUZANNE F BENJAMIN FNP

Provider Business Mailing Address
First Line	:	4222 N 12TH ST STE 102
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-6023
Country	:	US
Telephone Number	:	602-265-4357
Fax Number	:	602-604-9352

Provider Business Practice Location Address
First Line	:	4222 N 12TH ST STE 102
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-6023
Country	:	US
Telephone Number	:	602-265-4357
Fax Number	:	602-604-9352

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	03/03/2014

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