Provider Demographics
NPI:1124615869
Name:BENJAMIN-MLYNARCZUK, SUSAN MARGARET (MSN, RN, NPD-BC)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MARGARET
Last Name:BENJAMIN-MLYNARCZUK
Suffix:
Gender:F
Credentials:MSN, RN, NPD-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1134 MILDRED AVE
Mailing Address - Street 2:
Mailing Address - City:ANDALUSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19020-6432
Mailing Address - Country:US
Mailing Address - Phone:215-526-7525
Mailing Address - Fax:
Practice Address - Street 1:1134 MILDRED AVE
Practice Address - Street 2:
Practice Address - City:ANDALUSIA
Practice Address - State:PA
Practice Address - Zip Code:19020-6432
Practice Address - Country:US
Practice Address - Phone:215-244-9669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN258994L163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine