Basic Information
| Provider Information | |||||||||
| NPI: | 1780916098 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BENSON | ||||||||
| FirstName: | TERI | ||||||||
| MiddleName: | ANN PORTER | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10900 W 44TH AVE UNIT 200 | ||||||||
| Address2: | STE. 220 | ||||||||
| City: | WHEAT RIDGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800332742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033799371 | ||||||||
| FaxNumber: | 3032844082 | ||||||||
| Practice Location | |||||||||
| Address1: | 10900 W 44TH AVE UNIT 200 | ||||||||
| Address2: | STE. 220 | ||||||||
| City: | WHEAT RIDGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800332742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039931330 | ||||||||
| FaxNumber: | 3039575757 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2010 | ||||||||
| LastUpdateDate: | 10/23/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 10139 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 89836286 | 05 | CO | MEDICAID | P01306245 | 01 | CO | RR MCR | OTHER |