Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 4704272358 | MI |
N | 363LG0600X | Nurse Practitioner - Gerontology | 4704272358 | MI |
NPI | 1053737080 |
---|---|
Provider Name | Jessica Benitez |
First Address | Concord, NH 03303-1042 |
Second Address | Concord, NH 03301-7504 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2014 |
Last Update Date | 28/07/2015 |