Provider Demographics
NPI:1881638641
Name:BENIT, MARIA ALEKSANDROVNA (PA)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ALEKSANDROVNA
Last Name:BENIT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 290
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49058-0290
Mailing Address - Country:US
Mailing Address - Phone:269-945-9520
Mailing Address - Fax:269-945-3368
Practice Address - Street 1:840 COOK RD
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MI
Practice Address - Zip Code:49058-9616
Practice Address - Country:US
Practice Address - Phone:269-945-9520
Practice Address - Fax:269-945-3368
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601004499363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7417687OtherAETNA
MIMB1397997OtherDEA
MI7417687OtherAETNA
MIMB1397997OtherDEA