Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 3553 | MN |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 2014020750 | MN |
NPI | 1033516570 |
---|---|
Provider Name | Lauren Benolkin |
First Address | Shakopee, MN 55379-3384 |
Second Address | Shakopee, MN 55379-3384 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2014 |
Last Update Date | 11/03/2021 |