Healthcare Provider Details

I. General information

NPI: 1245020213
Provider Name (Legal Business Name): ANA I VALDES BENCOMO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 GORDON GUTMANN BLVD STE 201
JEFFERSONVILLE IN
47130-3766
US

IV. Provider business mailing address

3403 ROWENA RD APT 3
LOUISVILLE KY
40218-1339
US

V. Phone/Fax

Practice location:
  • Phone: 812-282-6114
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number09000518C
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: