Provider Demographics
NPI:1104889658
Name:BENVENUTI, NIKKI B (PA)
Entity type:Individual
Prefix:
First Name:NIKKI
Middle Name:B
Last Name:BENVENUTI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:NIKKI
Other - Middle Name:B
Other - Last Name:BESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:660 ACKERMAN RD
Mailing Address - Street 2:PO BOX 183103
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-4500
Mailing Address - Country:US
Mailing Address - Phone:614-293-2663
Mailing Address - Fax:614-293-2053
Practice Address - Street 1:2050 KENNEY ROAD
Practice Address - Street 2:SUITE 3300
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221
Practice Address - Country:US
Practice Address - Phone:614-293-2663
Practice Address - Fax:614-293-2053
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50001547363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P09541Medicare UPIN
OHPA15544Medicare PIN