Provider Demographics
NPI:1215078928
Name:BENASSI-POWLES, THERESA M (APN CNP)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:M
Last Name:BENASSI-POWLES
Suffix:
Gender:F
Credentials:APN CNP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:601 JAMES R THOMPSON BLVD
Mailing Address - Street 2:BUILDING D 2015
Mailing Address - City:EAST SAINT LOUIS
Mailing Address - State:IL
Mailing Address - Zip Code:62201-1129
Mailing Address - Country:US
Mailing Address - Phone:618-482-6959
Mailing Address - Fax:618-482-8311
Practice Address - Street 1:601 JAMES R THOMPSON BLVD
Practice Address - Street 2:BUILDING D 2015
Practice Address - City:EAST SAINT LOUIS
Practice Address - State:IL
Practice Address - Zip Code:62201-1129
Practice Address - Country:US
Practice Address - Phone:618-482-6959
Practice Address - Fax:618-482-8311
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics