Provider Demographics
NPI:1205469285
Name:BENECKE, SUZETTE ELISE (RN, CLE, CCL,)
Entity type:Individual
Prefix:
First Name:SUZETTE
Middle Name:ELISE
Last Name:BENECKE
Suffix:
Gender:F
Credentials:RN, CLE, CCL,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2628 ELIZABETH PKWY
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89406-5895
Mailing Address - Country:US
Mailing Address - Phone:775-835-9190
Mailing Address - Fax:
Practice Address - Street 1:2628 ELIZABETH PKWY
Practice Address - Street 2:
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89406-5895
Practice Address - Country:US
Practice Address - Phone:775-835-9190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCCL-771252163WL0100X
NV7-201712174H00000X
NVNV22619163WX0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WX0003XNursing Service ProvidersRegistered NurseObstetric, InpatientGroup - Single Specialty
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty