Provider Demographics
NPI:1700950003
Name:MEYER, BENNETTE E (CNP)
Entity Type:Individual
Prefix:
First Name:BENNETTE
Middle Name:E
Last Name:MEYER
Suffix:
Gender:F
Credentials:CNP
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Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:MSC06 3870 1 UNIV OF NM
Mailing Address - Street 2:UNM STUDENT HEALTH CENTER
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131-0001
Mailing Address - Country:US
Mailing Address - Phone:505-277-3136
Mailing Address - Fax:505-277-5668
Practice Address - Street 1:MSC06 3870 1 UNIVERSITY OF NEW MEXICO
Practice Address - Street 2:UNM STUDENT HEALTH CENTER
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-277-3136
Practice Address - Fax:505-277-5668
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMR12083363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
L0506Medicare UPIN