Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | R0042541 | OK |
NPI | 1003029638 |
---|---|
Provider Name | Ann R Benson |
First Address | Prague, OK 74864-4044 |
Second Address | Oklahoma City, OK 73117-1207 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 08/07/2007 |