Provider Demographics
NPI:1548362981
Name:BENSON, JANET M (NP)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:M
Last Name:BENSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 BREWSTER STREET
Mailing Address - Street 2:WOOD BLDG #516
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-4400
Mailing Address - Country:US
Mailing Address - Phone:401-729-3481
Mailing Address - Fax:
Practice Address - Street 1:174 ARMISTICE BLVD
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860
Practice Address - Country:US
Practice Address - Phone:401-729-3800
Practice Address - Fax:401-722-2292
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RINP37306363L00000X
MANP 124790363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIJB47992Medicaid
RI007060973OtherMEDICARE PTAN
RI007060973OtherMEDICARE PTAN