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NPI Code Detail

MEDICARE: MR. BENJAMIN C PEET RN

MEDICARE: MR. BENJAMIN C PEET RN
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
1163WP0809XAdult Psychiatric/Mental Health Registered NurseR57364NM

General Provider Information

NPI Number : 1871873653
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BENJAMIN C PEET RN
Provider Business Mailing Address
First Line : PO BOX 25884
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87125-0884
Country : US
Telephone Number : 505-884-4464
Fax Number :
Provider Business Practice Location Address
First Line : 700 2ND ST NW
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87102-1578
Country : US
Telephone Number : 505-884-4464
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2011
Last Update Date : 08/24/2011

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