Healthcare Provider Details

I. General information

NPI: 1922787563
Provider Name (Legal Business Name): CARMEN BENSON FNP-C, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARMEN VIGIL RN

II. Dates (important events)

Enumeration Date: 07/12/2023
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 S CHRISTOPHER RD
BELEN NM
87002
US

IV. Provider business mailing address

1436 WIND RIDGE DR NW
ALBUQUERQUE NM
87120-3893
US

V. Phone/Fax

Practice location:
  • Phone: 505-864-5454
  • Fax:
Mailing address:
  • Phone: 505-720-7247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number74603
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: