Healthcare Provider Details

I. General information

NPI: 1720511983
Provider Name (Legal Business Name): KRISTIN BENANTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2017
Last Update Date: 11/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 THOMAS JOHNSON DR STE A
FREDERICK MD
21702-4683
US

IV. Provider business mailing address

13406 NORDEN DR
SILVER SPRING MD
20906-5347
US

V. Phone/Fax

Practice location:
  • Phone: 240-215-6370
  • Fax: 240-439-8910
Mailing address:
  • Phone: 781-771-7254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR218730
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: