Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | 201150159 | OR |
Y | 363LA2200X | Nurse Practitioner - Adult Health | 201150159NP | OR |
NPI | 1013260181 |
---|---|
Provider Name | Ms. Sharon Louise Benjamin |
First Address | Forest Grove, OR 97116 |
Second Address | Forest Grove, OR 97116 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2012 |
Last Update Date | 19/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
500653197 | (05) | OR |
MB2531970 | DEA (01) | OR |