Provider Demographics
NPI:1760733273
Name:BENAFIELD, CHARLES HENRY (RN, PHN)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:HENRY
Last Name:BENAFIELD
Suffix:
Gender:M
Credentials:RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4738 GROUSE RUN DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5361
Mailing Address - Country:US
Mailing Address - Phone:209-675-1472
Mailing Address - Fax:
Practice Address - Street 1:4738 GROUSE RUN DR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5361
Practice Address - Country:US
Practice Address - Phone:209-675-1472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-24
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA821565163W00000X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse