Individual
JEAN LAZENBY BENTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
111 E THIRD AVE, GASTONIA, NC 28052-4343
(704) 874-3300
(704) 874-0065
Mailing address
200 E 2ND AVE, GASTONIA, NC 28052-4358
(704) 874-1904
(704) 867-2134
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
200956
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7000985
—
NC
Enumeration date
06/23/2005
Last updated
10/16/2019
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