Healthcare Provider Details

I. General information

NPI: 1841713112
Provider Name (Legal Business Name): DAREENA ELAINE BENAVIDES NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 01/07/2025
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 ELM ST NE
ALBUQUERQUE NM
87102-2512
US

IV. Provider business mailing address

P.O. BOX 27935
ALBUQUERQUE NM
87125
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-8360
  • Fax: 505-727-8768
Mailing address:
  • Phone: 505-727-8360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP-03336
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: