Provider Demographics
NPI:1518769561
Name:BENALLY, STEPHANIE ALICE
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ALICE
Last Name:BENALLY
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:PO BOX 315
Mailing Address - Street 2:
Mailing Address - City:PINON
Mailing Address - State:AZ
Mailing Address - Zip Code:86510-0315
Mailing Address - Country:US
Mailing Address - Phone:505-979-8085
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 315
Practice Address - Street 2:
Practice Address - City:PINON
Practice Address - State:AZ
Practice Address - Zip Code:86510-0315
Practice Address - Country:US
Practice Address - Phone:505-979-8085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker