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Individual

FRED BENSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
OWNER

Contact information

Practice address
2478 LAKE AVE, FORT WAYNE, IN 46805-5406
(260) 387-6396
(260) 387-6370
Mailing address
2478 LAKE AVE, FORT WAYNE, IN 46805-5406
(260) 387-6396
(260) 387-6370

Taxonomy

Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
27064077A
IN

Other

Enumeration date
09/01/2022
Last updated
09/01/2022
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