Provider Demographics
NPI:1699568899
Name:BENSON, ANNETTE (RN)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:BENSON
Suffix:
Gender:X
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1059 MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56096-1234
Mailing Address - Country:US
Mailing Address - Phone:612-644-2076
Mailing Address - Fax:
Practice Address - Street 1:1059 MAPLE DR
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:MN
Practice Address - Zip Code:56096-1234
Practice Address - Country:US
Practice Address - Phone:612-644-2076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X
MN1203453163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No174H00000XOther Service ProvidersHealth Educator