Healthcare Provider Details

I. General information

NPI: 1639803729
Provider Name (Legal Business Name): ALLISON E BENSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2022
Last Update Date: 07/13/2022
Certification Date: 07/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 CALLE ADELANTE
ESPANOLA NM
87532-3464
US

IV. Provider business mailing address

PO BOX 1053
ALCALDE NM
87511-1053
US

V. Phone/Fax

Practice location:
  • Phone: 505-929-4555
  • Fax:
Mailing address:
  • Phone: 505-929-4555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number59524
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code163WR1000X
TaxonomyReproductive Endocrinology/Infertility Registered Nurse
License Number59524
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License Number59524
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code163WX1500X
TaxonomyOstomy Care Registered Nurse
License Number59524
License Number StateNM
# 5
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number59524
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: