Provider Demographics
NPI:1154399897
Name:BENASUTTI, MARGRET (ANP)
Entity type:Individual
Prefix:MRS
First Name:MARGRET
Middle Name:
Last Name:BENASUTTI
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1927
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81502-1927
Mailing Address - Country:US
Mailing Address - Phone:970-986-3622
Mailing Address - Fax:970-683-5249
Practice Address - Street 1:715 S 3RD ST
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-4209
Practice Address - Country:US
Practice Address - Phone:970-249-6737
Practice Address - Fax:970-252-0112
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO97117174400000X
COAPN.0000852-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO80580050Medicaid
CO07971179Medicaid
COS13178Medicare UPIN
COC366238Medicare ID - Type UnspecifiedINDIVIDUAL ID#
CO80580050Medicaid