Provider Demographics
NPI:1134275456
Name:BENSON, MINDY S (RN MSN PNP)
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:S
Last Name:BENSON
Suffix:
Gender:F
Credentials:RN MSN PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:889 54TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94608-3238
Mailing Address - Country:US
Mailing Address - Phone:510-428-1228
Mailing Address - Fax:
Practice Address - Street 1:5220 CLAREMONT AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1033
Practice Address - Country:US
Practice Address - Phone:510-428-3885
Practice Address - Fax:510-547-2702
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA380831363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics