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General NPI Number Information
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NPI Number | 1760279228
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Entity Type | Organization
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Legal Business Name | MAEB PLLC
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Dates
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Enumeration Date | 04/21/2025
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | 154 HUFFMAN MILL RD STE 203
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City | BURLINGTON
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State | NC
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Zip | 27215-5113
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Country | US
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Telephone | 336-298-8088
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Fax | 464-777-8135
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Provider Business Mailing Address
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Address Line | PO BOX 3
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City | MC LEANSVILLE
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State | NC
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Zip | 27301-0003
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Country | US
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Telephone | 336-298-8088
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Fax | 464-777-8135
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Authorized Official
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Title or Position | OWNER/CEO
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Name | MRS. CAEDORA MARYLOUISE BENTON
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Credential | NP
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Telephone | 678-499-7794
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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