Provider Demographics
NPI:1780428896
Name:BENOIT, CHRISTINA (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:
Last Name:BENOIT
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:ALTAVESTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 54
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-0054
Mailing Address - Country:US
Mailing Address - Phone:781-504-9912
Mailing Address - Fax:
Practice Address - Street 1:52 SECOND AVE STE 4000
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-1156
Practice Address - Country:US
Practice Address - Phone:781-504-9912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2273123163W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse