Healthcare Provider Details

I. General information

NPI: 1245135490
Provider Name (Legal Business Name): SUMMER M BENAVIDES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 LINCOLN ST
SITKA AK
99835-7651
US

IV. Provider business mailing address

805 LINCOLN ST
SITKA AK
99835-7651
US

V. Phone/Fax

Practice location:
  • Phone: 816-937-0170
  • Fax:
Mailing address:
  • Phone: 816-937-0170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: