Provider Demographics
NPI:1689088874
Name:BENEK, MARY HANNAH (CNM MN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:HANNAH
Last Name:BENEK
Suffix:
Gender:F
Credentials:CNM MN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-8003
Mailing Address - Country:US
Mailing Address - Phone:912-490-2229
Mailing Address - Fax:912-490-9023
Practice Address - Street 1:505 CITY BLVD
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-8003
Practice Address - Country:US
Practice Address - Phone:912-490-2229
Practice Address - Fax:912-490-9023
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN063022367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife