Provider Demographics
NPI:1316497514
Name:MICHELLE BENSON, APRN
Entity type:Organization
Organization Name:MICHELLE BENSON, APRN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:801-893-2221
Mailing Address - Street 1:6255 S MARGRAY DR
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84129-6321
Mailing Address - Country:US
Mailing Address - Phone:801-893-2221
Mailing Address - Fax:801-983-6290
Practice Address - Street 1:1108 W SOUTH JORDAN PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-5504
Practice Address - Country:US
Practice Address - Phone:801-893-2221
Practice Address - Fax:801-983-6290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT348263-4405251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health