Provider Demographics
NPI:1124411665
Name:GAHAN-BENSON, AIDA (RN)
Entity type:Individual
Prefix:
First Name:AIDA
Middle Name:
Last Name:GAHAN-BENSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 TERRITORY RD
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:NY
Mailing Address - Zip Code:13421-9304
Mailing Address - Country:US
Mailing Address - Phone:315-829-8701
Mailing Address - Fax:315-829-8732
Practice Address - Street 1:2 TERRITORY RD
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-9304
Practice Address - Country:US
Practice Address - Phone:315-829-8701
Practice Address - Fax:315-829-8732
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY593728163WA2000X, 163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WE0003XNursing Service ProvidersRegistered NurseEmergency