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General NPI Number Information
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NPI Number | 1386968899
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Entity Type | Individual
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Provider Name | LISA M BENEDETTO CNM
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Gender | Female
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Dates
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Enumeration Date | 03/26/2010
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Last Update Date | 05/16/2020
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Provider Practice Location Address
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Address Line | 132 INDIAN CREEK RD
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City | ITHACA
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State | NY
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Zip | 14850-1331
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Country | US
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Telephone | 607-379-9606
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Fax | 607-821-4374
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Provider Business Mailing Address
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Address Line | 132 INDIAN CREEK RD
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City | ITHACA
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State | NY
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Zip | 14850-1331
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Country | US
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Telephone | 607-379-9606
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Fax | 607-821-4374
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 171868
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 13010
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | F00149-1
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License Number State | NY
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