Provider Demographics
NPI:1942607338
Name:CHILIKWELA, BENITA
Entity Type:Individual
Prefix:
First Name:BENITA
Middle Name:
Last Name:CHILIKWELA
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 1:10282 E GRAY HAWK DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85730-6116
Mailing Address - Country:US
Mailing Address - Phone:520-406-0788
Mailing Address - Fax:
Practice Address - Street 1:1402 N ALVERNON WAY
Practice Address - Street 2:SUITE S3
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-3804
Practice Address - Country:US
Practice Address - Phone:520-406-0788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-01
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK148861164W00000X
AZLP049532164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse