| Doctor Name: | MRS. LAURA ANN BENACK |
| NPI Number: | 1053698969 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | 2011036334 |
| Business Practice Address: | 150 Entrance Way Saint Peters, MO - 633761645 |
| Business Phone Number: | 6369169920 |
| Business Fax Number: | 6369169176 |
| Mailing Address: | 670 Mason Ridge Center Dr, Ste 300 SAINT LOUIS |
| State: | MO |
| Postal Code: | 631418573 |
| Phone Number: | 6369169920 |
| Fax Number: | 6369169176 |
| NPI Enumeration Date: | 11/05/2011 |
| NPI Last Update Date: | 06/24/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 2011036334 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |