Provider Demographics
NPI:1982090601
Name:BENALLY, ETHELINDA W
Entity type:Individual
Prefix:
First Name:ETHELINDA
Middle Name:W
Last Name:BENALLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ETHELINDA
Other - Middle Name:
Other - Last Name:WHITEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:ATTN: PHN
Mailing Address - City:SHIPROCK
Mailing Address - State:NM
Mailing Address - Zip Code:87420-0160
Mailing Address - Country:US
Mailing Address - Phone:505-368-7405
Mailing Address - Fax:505-368-7416
Practice Address - Street 1:US HWY 491 N
Practice Address - Street 2:NORTHERN NAVAJO MEDICAL CENTER
Practice Address - City:SHIPROCK
Practice Address - State:NM
Practice Address - Zip Code:87420
Practice Address - Country:US
Practice Address - Phone:505-368-7405
Practice Address - Fax:505-368-7416
Is Sole Proprietor?:No
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR48677163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health