Ann Elizabeth Benner, PNP
Individual provider Active NPI Pediatric Nurse Practitioner · Canton, NY
NPI 1578850558 · NPPES record last updated Nov 25, 2025
Key facts
- NPI
- 1578850558
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Nurse Practitioner 363LP0200X
- License
- 382969 (NY)
- Practice address
- 80 E Main St
Canton, NY 13617-1450 - Phone
- (315) 261-5615
- Fax
- (315) 261-7183
- NPI assigned
- Jun 29, 2011
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190830001997 | NY | Practitioner - Nurse Practitioner | 8123357019 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22570374 | NY | MD | School Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Canton-Potsdam Hospital | Current |
Accepting new patients | |
| Canton-Potsdam Hospital | Current |
Accepting new patients | |
| Canton Potsdam Hospital | Past | Accepting new patients |
Locations
80 E Main St
Canton, NY 13617
Phone (315) 261-6034
201 Market St
Ste E
Potsdam, NY 13676
Phone (315) 274-9102
50 Leroy St
Potsdam, NY 13676
Phone (315) 261-6034
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Registered Nurse | 163WS0200X | 22570374 | NY | |
| Pediatric Nurse Practitioner | 363LP0200X | 382969 | NY | Yes |
| Registered Nurse | 163W00000X | 22570374 | NY |
Addresses
Primary practice location
80 E Main St
Canton, NY 13617-1450
Mailing address
50 Leroy St
Potsdam, NY 13676-1799
Phone (315) 265-3300
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | apetroccione337436@direct.rochesterregional.org |
Other providers in Canton, NY
- Tonya Lynn Bassett
- Andrea Bates
- John William Batich
- Linda Greene Beauchamp
- Caitlin Beeson
- Jennifer Ann Benson
- Debra Jean Benware
- Florence C Bero
- Chelsea Bice
- Linanne None Bice
All providers in Canton, NY · Pediatric Nurse Practitioner in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 25, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.