Provider Demographics
NPI:1346963303
Name:BENESOVSKY, STANISLAVA MONIKA (RN, NP)
Entity Type:Individual
Prefix:
First Name:STANISLAVA
Middle Name:MONIKA
Last Name:BENESOVSKY
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 AVENUE F
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-5008
Mailing Address - Country:US
Mailing Address - Phone:310-755-4665
Mailing Address - Fax:
Practice Address - Street 1:212 AVENUE F
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5008
Practice Address - Country:US
Practice Address - Phone:310-755-4665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-23
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95023075363LF0000X
CA95066198163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical