Provider Demographics
NPI:1962717702
Name:BENITEZ, PHILIP H (RN)
Entity type:Individual
Prefix:MISS
First Name:PHILIP
Middle Name:H
Last Name:BENITEZ
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12603 W NEEDHAM DR
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-1849
Mailing Address - Country:US
Mailing Address - Phone:262-786-6229
Mailing Address - Fax:
Practice Address - Street 1:12603 W NEEDHAM DR
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-1849
Practice Address - Country:US
Practice Address - Phone:262-786-6229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI139240-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse