Provider Demographics
NPI:1982257390
Name:BENSON, SARA JENNIFER
Entity type:Individual
Prefix:MS
First Name:SARA
Middle Name:JENNIFER
Last Name:BENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1497 ALCATRAZ AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94702-2710
Mailing Address - Country:US
Mailing Address - Phone:510-653-1843
Mailing Address - Fax:510-844-0131
Practice Address - Street 1:1497 ALCATRAZ AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94702-2710
Practice Address - Country:US
Practice Address - Phone:510-653-1843
Practice Address - Fax:510-844-0131
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95137156363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health