Provider Demographics
NPI:1508269119
Name:BENBOW, BEAUTINE (CRNP)
Entity Type:Individual
Prefix:
First Name:BEAUTINE
Middle Name:
Last Name:BENBOW
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 SOLLY AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-1923
Mailing Address - Country:US
Mailing Address - Phone:512-651-5623
Mailing Address - Fax:
Practice Address - Street 1:8001 STATE RD
Practice Address - Street 2:MOD II, SUITE 106
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19136-2908
Practice Address - Country:US
Practice Address - Phone:215-624-2565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-28
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA00241770462084P0800X
PASP014229363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry