Donna L Benedicktus, LMP
Individual provider Active NPI Contractor · Vancouver, WA
NPI 1871895409 · NPPES record last updated Dec 2, 2010
Key facts
- NPI
- 1871895409
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- License
- MA00004696 (WA)
- Practice address
- 210 E Evergreen Blvd
Vancouver, WA 98660 - Phone
- (360) 693-3693
- Fax
- (360) 693-6894
- NPI assigned
- Dec 2, 2010
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA00004696 | WA | MD | Contractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | MA00004696 | WA | Yes |
Addresses
Primary practice location
210 E Evergreen Blvd
Vancouver, WA 98660
Mailing address
210 E Evergreen Blvd
Vancouver, WA 98660
Phone (360) 693-3693
Other providers in Vancouver, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 2, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.