Provider Demographics
NPI:1487432076
Name:BENEDICT, HANNAH LAUREL ROSE
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:LAUREL ROSE
Last Name:BENEDICT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 EDWARDS VILLAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:EDWARDS
Mailing Address - State:CO
Mailing Address - Zip Code:81632-5277
Mailing Address - Country:US
Mailing Address - Phone:563-213-3204
Mailing Address - Fax:
Practice Address - Street 1:210 EDWARDS VILLAGE BLVD
Practice Address - Street 2:
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632-5277
Practice Address - Country:US
Practice Address - Phone:563-213-3204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program