Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | RN093585 | GA |
NPI | 1003815838 |
---|---|
Provider Name | Mrs. Janna Benston |
First Address | Atlanta, GA 30328-5382 |
Second Address | Atlanta, GA 30328-5382 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2005 |
Last Update Date | 19/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00848526B | (05) | GA |
00848526D | (05) | GA |