MEDICARE: MAYLENE BENES FNP-BC

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	209008040	IL
2	363LF0000X	Family Nurse Practitioner	277001652	IL

General Provider Information

NPI Number	:	1952614778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYLENE BENES FNP-BC

Provider Business Mailing Address
First Line	:	1610 COMMONS DR
Second Line	:
City	:	GENEVA
State	:	IL
Zip	:	60134-2531
Country	:	US
Telephone Number	:	331-444-2507
Fax Number	:

Provider Business Practice Location Address
First Line	:	1610 COMMONS DR
Second Line	:
City	:	GENEVA
State	:	IL
Zip	:	60134-2531
Country	:	US
Telephone Number	:	331-444-2507
Fax Number	:

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

Provider Enumeration Date	:	07/21/2010
Last Update Date	:	01/25/2023

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Directions to “ MAYLENE BENES FNP-BC” Practice Location

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