Provider Demographics
NPI:1053834945
Name:LOUISSAINT, BENITHO (NP)
Entity Type:Individual
Prefix:MR
First Name:BENITHO
Middle Name:
Last Name:LOUISSAINT
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6197 S RURAL RD
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-2909
Mailing Address - Country:US
Mailing Address - Phone:480-471-8980
Mailing Address - Fax:480-912-1061
Practice Address - Street 1:6197 S RURAL RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-2909
Practice Address - Country:US
Practice Address - Phone:480-471-8980
Practice Address - Fax:480-912-1061
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-23
Last Update Date:2023-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP10399363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily