Provider Demographics
NPI:1972046530
Name:AMUN-RA, BENU
Entity Type:Individual
Prefix:MISS
First Name:BENU
Middle Name:
Last Name:AMUN-RA
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:PO BOX 13921
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80201-3921
Mailing Address - Country:US
Mailing Address - Phone:720-988-4963
Mailing Address - Fax:
Practice Address - Street 1:4779 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:FT. COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526
Practice Address - Country:US
Practice Address - Phone:720-988-4963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO040330679343900000X
385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)