Provider Demographics
NPI:1730827932
Name:LOVATO, BENITA RAE (RN)
Entity type:Individual
Prefix:
First Name:BENITA
Middle Name:RAE
Last Name:LOVATO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:BENITA
Other - Middle Name:RAE
Other - Last Name:LOVATO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BENITA LOVATO MSN RN
Mailing Address - Street 1:24 PUESTA DEL SOL
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-9158
Mailing Address - Country:US
Mailing Address - Phone:505-917-5762
Mailing Address - Fax:
Practice Address - Street 1:235 PASEO DEL CANON E
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6239
Practice Address - Country:US
Practice Address - Phone:575-737-6000
Practice Address - Fax:575-737-6001
Is Sole Proprietor?:No
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRN-87214163WE0003X, 163WP2201X, 163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMRN-87214OtherNMBON NURSING LICENSE NUMBER