Provider Demographics
NPI:1508618299
Name:BENOIT, AMANDA J
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:J
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 1:3291 EASTGATE ST
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48519-1554
Mailing Address - Country:US
Mailing Address - Phone:810-814-6539
Mailing Address - Fax:
Practice Address - Street 1:3291 EASTGATE ST
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48519-1554
Practice Address - Country:US
Practice Address - Phone:810-814-6539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care