MEDICARE: DEANNA M BENOIT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1659432557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEANNA M BENOIT

Provider Business Mailing Address
First Line	:	595 ALLEN RD
Second Line	:
City	:	KIMBALL
State	:	MI
Zip	:	48074-3801
Country	:	US
Telephone Number	:	810-388-1200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1127 WATER ST
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-4468
Country	:	US
Telephone Number	:	810-388-1200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	07/08/2007

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