MEDICARE: ROSALYN T BENSON NP

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	163WS0200X	School Registered Nurse	507989	CA
2	363LA2100X	Acute Care Nurse Practitioner	11707	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11707	OTHER	CA	NURSE PRACTITIONER
2	507989	OTHER	CA	REGISTERED NURSE

General Provider Information

NPI Number	:	1386931665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSALYN T BENSON NP

Provider Business Mailing Address
First Line	:	15078 CALLE DEL ORO
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-5069
Country	:	US
Telephone Number	:	909-606-9692
Fax Number	:

Provider Business Practice Location Address
First Line	:	15078 CALLE DEL ORO
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-5069
Country	:	US
Telephone Number	:	909-606-9692
Fax Number	:

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

Provider Enumeration Date	:	07/07/2011
Last Update Date	:	07/07/2011

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