Healthcare Provider Details

I. General information

NPI: 1487478541
Provider Name (Legal Business Name): JANA ROSE BENAD CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 11/14/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2019 GALISTEO ST STE A3
SANTA FE NM
87505-2143
US

IV. Provider business mailing address

2019 GALISTEO ST STE A3
SANTA FE NM
87505-2143
US

V. Phone/Fax

Practice location:
  • Phone: 505-988-2117
  • Fax:
Mailing address:
  • Phone: 505-988-2117
  • Fax: 505-988-2119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number81411
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: