Provider Demographics
NPI:1902523608
Name:BENAVIDES, CRYSTAL (RN)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:
Last Name:BENAVIDES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:DUARTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7744 E 42ND PL
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-8461
Mailing Address - Country:US
Mailing Address - Phone:910-644-3718
Mailing Address - Fax:
Practice Address - Street 1:7150 E 24TH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365-1179
Practice Address - Country:US
Practice Address - Phone:928-502-6442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ228452163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool