Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 341959 | NY |
NPI | 1003314956 |
---|---|
Provider Name | Mariella Benavides |
First Address | Brooklyn, NY 11238-5558 |
Second Address | New York, NY 10016-6402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2018 |
Last Update Date | 25/01/2018 |