Provider Demographics
NPI:1396016630
Name:BENTON, DEBORAH KAY (RN)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:KAY
Last Name:BENTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18302 W BURTON AVE
Mailing Address - Street 2:
Mailing Address - City:WADDELL
Mailing Address - State:AZ
Mailing Address - Zip Code:85355-4275
Mailing Address - Country:US
Mailing Address - Phone:623-876-7450
Mailing Address - Fax:623-876-7461
Practice Address - Street 1:18302 W BURTON AVE
Practice Address - Street 2:
Practice Address - City:WADDELL
Practice Address - State:AZ
Practice Address - Zip Code:85355-4275
Practice Address - Country:US
Practice Address - Phone:623-876-7450
Practice Address - Fax:623-876-7461
Is Sole Proprietor?:No
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN171388163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool