=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235949694
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BIANCA BENINCASA HUNTER STUDENT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2025
-----------------------------------------------------
Last Update Date | 01/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 JOHN MARSHALL DR
-----------------------------------------------------
City | HUNTINGTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25755-0003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-696-3170
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 306 HEATH RD
-----------------------------------------------------
City | HURRICANE
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25526-9006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-951-0866
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------