Provider Demographics
NPI:1639853708
Name:ENI, BENEDICTA NKECHI
Entity Type:Individual
Prefix:
First Name:BENEDICTA
Middle Name:NKECHI
Last Name:ENI
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 1:2406 WILDWIND RD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88007-5503
Mailing Address - Country:US
Mailing Address - Phone:800-315-5105
Mailing Address - Fax:
Practice Address - Street 1:8401 SPAIN RD NE APT 45A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2025
Practice Address - Country:US
Practice Address - Phone:404-933-1532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM54930313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility