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General NPI Number Information
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NPI Number | 1689912107
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Entity Type | Organization
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Legal Business Name | BEHNAWA PLLC
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Dates
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Enumeration Date | 01/17/2013
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Last Update Date | 09/12/2013
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Provider Practice Location Address
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Address Line | 1500 AVENUE H
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City | ELY
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State | NV
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Zip | 89301-2615
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Country | US
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Telephone | 702-453-3799
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Fax | 702-453-5741
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Provider Business Mailing Address
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Address Line | 1402 LAKE TAPPS PKWY SE STE 104-288
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City | AUBURN
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State | WA
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Zip | 98092-8157
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Country | US
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Telephone | 702-453-3799
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Fax | 702-453-5741
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Authorized Official
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Title or Position | ACCTS MGR
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Name | LORI LABRECQUE
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Credential |
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Telephone | 702-453-3799
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 14179
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 14179
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License Number State | NV
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