Provider Demographics
NPI:1225485931
Name:BENOIT, MICHELENE
Entity Type:Individual
Prefix:
First Name:MICHELENE
Middle Name:
Last Name:BENOIT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2014 E CHELTEN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19138-3014
Mailing Address - Country:US
Mailing Address - Phone:267-730-7990
Mailing Address - Fax:215-438-8850
Practice Address - Street 1:2014 E CHELTEN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19138-3014
Practice Address - Country:US
Practice Address - Phone:267-730-7990
Practice Address - Fax:215-438-8850
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-23
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL374U00000X
PA9301849376K00000X
390200000X
PA390200000X
FLCNA175604376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1225485931Medicaid
FL352526795OtherNURSE REGISTRY
FL022302100Medicaid