Provider Demographics
NPI:1356467450
Name:AVNER, BELINA (PA)
Entity Type:Individual
Prefix:MRS
First Name:BELINA
Middle Name:
Last Name:AVNER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 SOUTH CHRISTOPHER ROAD
Mailing Address - Street 2:
Mailing Address - City:BELEN
Mailing Address - State:NM
Mailing Address - Zip Code:87002-2617
Mailing Address - Country:US
Mailing Address - Phone:505-864-7781
Mailing Address - Fax:505-864-3360
Practice Address - Street 1:703 SOUTH CHRISTOPHER ROAD
Practice Address - Street 2:
Practice Address - City:BELEN
Practice Address - State:NM
Practice Address - Zip Code:87002-2617
Practice Address - Country:US
Practice Address - Phone:505-864-7781
Practice Address - Fax:505-864-3360
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102801363A00000X
NMPA2008-0062363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM85125750Medicaid
NM85125750Medicaid