Provider Demographics
NPI:1588304455
Name:BENUSA, JAMIE LYNN (APRN, CNP)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNN
Last Name:BENUSA
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:LYNN
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3680 INDEPENDENCE AVE S APT 82
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-3760
Mailing Address - Country:US
Mailing Address - Phone:952-270-5054
Mailing Address - Fax:
Practice Address - Street 1:2530 CHICAGO AVE STE 500
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-4291
Practice Address - Country:US
Practice Address - Phone:612-813-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8772363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily