MEDICARE: NIKKI B BENVENUTI PA

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	363A00000X	Physician Assistant	50001547	OH

General Provider Information

NPI Number	:	1104889658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIKKI B BENVENUTI PA

Provider Business Mailing Address
First Line	:	660 ACKERMAN RD
Second Line	:	PO BOX 183103
City	:	COLUMBUS
State	:	OH
Zip	:	43202-4500
Country	:	US
Telephone Number	:	614-293-2663
Fax Number	:	614-293-2053

Provider Business Practice Location Address
First Line	:	2050 KENNEY ROAD
Second Line	:	SUITE 3300
City	:	COLUMBUS
State	:	OH
Zip	:	43221
Country	:	US
Telephone Number	:	614-293-2663
Fax Number	:	614-293-2053

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

Provider Enumeration Date	:	04/07/2006
Last Update Date	:	03/03/2009

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Directions to “ NIKKI B BENVENUTI PA” Practice Location

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