Individual
ANDRE TEDRELL BENSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1133 COLOMA WAY STE C, ROSEVILLE, CA 95661-4480
(916) 774-6647
Mailing address
1133 COLOMA WAY STE C, ROSEVILLE, CA 95661-4480
(916) 716-3570
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
VN147890
CA
Other
Enumeration date
11/05/2019
Last updated
11/05/2019
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