Provider Demographics
NPI:1760298665
Name:BENJES, JESSICA MACKENZIE (CRNP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MACKENZIE
Last Name:BENJES
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 BRIGHT STAR CT
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-2269
Mailing Address - Country:US
Mailing Address - Phone:717-824-6142
Mailing Address - Fax:
Practice Address - Street 1:8114 SANDPIPER CIR STE 100
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-5901
Practice Address - Country:US
Practice Address - Phone:410-933-8101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR233684363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics