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Individual

JESSICA LEEANN BENJAMIN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
2525 DONNA ST APT D, NORTH LAS VEGAS, NV 89030-5571
(909) 991-9464
Mailing address
2525 DONNA ST APT D, NORTH LAS VEGAS, NV 89030-5571
(909) 991-9464

Taxonomy

Speciality
Code
Description
License number
State
251T00000X
PACE Provider Organization
Primary
00016261488072701238
NV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
120027855
NV
Enumeration date
01/09/2023
Last updated
01/09/2023
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