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NPI Code Detail

MEDICARE: AMANDA BENJAMIN

MEDICARE: AMANDA BENJAMIN
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
1363LF0000XFamily Nurse Practitioner209012067IL
2363L00000XNurse Practitioner209-012067IL

General Provider Information

NPI Number : 1467859454
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA BENJAMIN
Provider Business Mailing Address
First Line : 900 RAND RD STE 300
Second Line :
City : DES PLAINES
State : IL
Zip : 60016-2359
Country : US
Telephone Number : 847-324-3976
Fax Number : 847-929-1154
Provider Business Practice Location Address
First Line : 951 ESSINGTON RD # 300
Second Line :
City : JOLIET
State : IL
Zip : 60435-8439
Country : US
Telephone Number : 815-744-4551
Fax Number : 815-744-4756
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/19/2014
Last Update Date : 12/15/2020

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Directions to “ AMANDA BENJAMIN ” Practice Location

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