Provider Demographics
NPI:1184443863
Name:ANYABINE, BENEDICTA (RN)
Entity type:Individual
Prefix:
First Name:BENEDICTA
Middle Name:
Last Name:ANYABINE
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:BENNIE
Other - Middle Name:
Other - Last Name:ANYABINE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:201 LAKE LIVINGSTON DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-7191
Mailing Address - Country:US
Mailing Address - Phone:512-363-8689
Mailing Address - Fax:
Practice Address - Street 1:435 BUCKLAND RD
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-3720
Practice Address - Country:US
Practice Address - Phone:860-268-2177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT14171363LP0808X
TX1179699363LP0808X
TX700958163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health