Provider Demographics
NPI:1902370927
Name:BENAVIDES, KRISTINE LOUISE KADOLPH (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:LOUISE KADOLPH
Last Name:BENAVIDES
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4215 NEWBURG RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-6479
Mailing Address - Country:US
Mailing Address - Phone:815-988-8500
Mailing Address - Fax:
Practice Address - Street 1:4215 NEWBURG RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-6479
Practice Address - Country:US
Practice Address - Phone:815-988-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-12
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209017840363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily