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Individual

LESA JOY BENTON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
7477 SE 52ND AVE, PORTLAND, OR 97206-8206
(503) 572-4196
Mailing address
7477 SE 52ND AVE, PORTLAND, OR 97206-8206
(503) 572-4196

Taxonomy

Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
AP61415533
WA
363LG0600X
Gerontology Nurse Practitioner
Primary
10007097
OR
363LG0600X
Gerontology Nurse Practitioner
AP61415533
WA

Other

Enumeration date
04/26/2023
Last updated
12/11/2023
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