Healthcare Provider Details

I. General information

NPI: 1609980465
Provider Name (Legal Business Name): CAROLYN GUST BENHEIM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 S 6TH AVE
TUCSON AZ
85723-0001
US

IV. Provider business mailing address

8556 N SAYANTE WAY
TUCSON AZ
85743-1405
US

V. Phone/Fax

Practice location:
  • Phone: 520-792-1450
  • Fax: 520-629-4972
Mailing address:
  • Phone: 520-792-1450
  • Fax: 520-629-4972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN034151
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: