Provider Demographics
NPI:1053698969
Name:BENACK, LAURA ANN (NP)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ANN
Last Name:BENACK
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Gender:F
Credentials:NP
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Mailing Address - Street 1:670 MASON RIDGE CENTER DR
Mailing Address - Street 2:STE 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8573
Mailing Address - Country:US
Mailing Address - Phone:636-916-9920
Mailing Address - Fax:636-916-9176
Practice Address - Street 1:150 ENTRANCE WAY
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1645
Practice Address - Country:US
Practice Address - Phone:636-916-9920
Practice Address - Fax:636-916-9176
Is Sole Proprietor?:No
Enumeration Date:2011-11-05
Last Update Date:2015-06-24
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Provider Licenses
StateLicense IDTaxonomies
MO2011036334363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health