Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | 209000672 | IL |
N | 363LC1500X | Nurse Practitioner - Community Health | 209-000672 | IL |
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 209-000672 | IL |
N | 363LP2300X | Nurse Practitioner - Primary Care | 209-000672 | IL |
NPI | 1992968143 |
---|---|
Provider Name | Mrs. Dessa Benton |
First Address | Chicago, IL 60636-1107 |
Second Address | Chicago, IL 60636-1107 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2008 |
Last Update Date | 08/07/2008 |