MEDICARE: MRS. RENA BENTON

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	2025046358	MI
2	163W00000X	Registered Nurse	4704389249	MI

General Provider Information

NPI Number	:	1962939926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RENA BENTON

Provider Business Mailing Address
First Line	:	12750 S SAGINAW ST STE 203
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-1841
Country	:	US
Telephone Number	:	810-493-0887
Fax Number	:

Provider Business Practice Location Address
First Line	:	12750 S SAGINAW ST STE 203
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-1841
Country	:	US
Telephone Number	:	810-624-6578
Fax Number	:	810-624-6578

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

Provider Enumeration Date	:	05/21/2017
Last Update Date	:	01/31/2026

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Directions to “ MRS. RENA BENTON ” Practice Location

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