Provider Demographics
NPI:1265100481
Name:BENAVIDES-VAELLO, SANDRA (APRN, FNP)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:BENAVIDES-VAELLO
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:BENAVIDES-VAELLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, PHD
Mailing Address - Street 1:501 S 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3550
Mailing Address - Country:US
Mailing Address - Phone:509-853-1082
Mailing Address - Fax:509-573-6275
Practice Address - Street 1:915 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:TIETON
Practice Address - State:WA
Practice Address - Zip Code:98947-9802
Practice Address - Country:US
Practice Address - Phone:509-673-0044
Practice Address - Fax:509-452-5224
Is Sole Proprietor?:No
Enumeration Date:2021-09-01
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61315689363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2224325Medicaid