Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | D12666 | MN |
Y | 213EG0000X | General Practice | D12666 | MN |
NPI | 1003043175 |
---|---|
Provider Name | Dr. Rebecca Leigh Benson |
First Address | St Louis Park, MN 55426-3612 |
Second Address | Richfield, MN 55423-2477 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2009 |
Last Update Date | 16/06/2009 |