Basic Information
Provider Information
NPI: 1669416525
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BENSON
FirstName: LINDA
MiddleName: A
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: MCALPINE
OtherFirstName: LINDA
OtherMiddleName: A
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 601 JOHN ST
Address2: BOX M510
City: KALAMAZOO
State: MI
PostalCode: 490075341
CountryCode: US
TelephoneNumber: 2693417762
FaxNumber: 2693418098
Practice Location
Address1: 601 JOHN ST
Address2: BOX 42
City: KALAMAZOO
State: MI
PostalCode: 490075341
CountryCode: US
TelephoneNumber: 2693416417
FaxNumber: 2693418743
Other Information
ProviderEnumerationDate: 06/15/2006
LastUpdateDate: 03/19/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LC0200X4704218394MIY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine

ID Information
IDTypeStateIssuerDescription
487301805MI MEDICAID


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