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General NPI Number Information
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NPI Number | 1154807725
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Entity Type | Individual
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Provider Name | ANDREA BENAVIDEZ PMHNP-BC, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 07/17/2018
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Last Update Date | 10/05/2023
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Provider Practice Location Address
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Address Line | 8417 WASHINGTON PL NE STE A
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City | ALBUQUERQUE
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State | NM
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Zip | 87113-1720
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Country | US
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Telephone | 505-273-9453
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Fax | 505-503-1619
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Provider Business Mailing Address
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Address Line | 8417 WASHINGTON PL NE STE A
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City | ALBUQUERQUE
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State | NM
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Zip | 87113-1720
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Country | US
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Telephone | 505-273-9453
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Fax | 505-503-1619
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 53299
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 53299
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License Number State | NM
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