MEDICARE: ROBERT JOHN BENON MSN, FNP

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	363LF0000X	Family Nurse Practitioner	R21020	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861417453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT JOHN BENON MSN, FNP

Provider Business Mailing Address
First Line	:	1880A CALLE QUEDO
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-5433
Country	:	US
Telephone Number	:	505-438-9139
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 YUCCA ST
Second Line	:	STUDENT SERVICES BLDG.
City	:	SANTA FE
State	:	NM
Zip	:	87505-5456
Country	:	US
Telephone Number	:	505-467-2439
Fax Number	:	505-467-2989

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

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

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