Provider Demographics
NPI:1154807725
Name:BENAVIDEZ, ANDREA (PMHNP-BC, FNP-C)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:BENAVIDEZ
Suffix:
Gender:F
Credentials:PMHNP-BC, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8417 WASHINGTON PL NE STE A
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1720
Mailing Address - Country:US
Mailing Address - Phone:505-273-9453
Mailing Address - Fax:505-503-1619
Practice Address - Street 1:8417 WASHINGTON PL NE STE A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-1720
Practice Address - Country:US
Practice Address - Phone:505-273-9453
Practice Address - Fax:505-503-1619
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM53299363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM53801555Medicaid