Provider Demographics
NPI:1760279228
Name:MAEB PLLC
Entity type:Organization
Organization Name:MAEB PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAEDORA
Authorized Official - Middle Name:MARYLOUISE
Authorized Official - Last Name:BENTON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:678-499-7794
Mailing Address - Street 1:PO BOX 3
Mailing Address - Street 2:
Mailing Address - City:MC LEANSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27301-0003
Mailing Address - Country:US
Mailing Address - Phone:336-298-8088
Mailing Address - Fax:464-777-8135
Practice Address - Street 1:154 HUFFMAN MILL RD STE 203
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-5113
Practice Address - Country:US
Practice Address - Phone:336-298-8088
Practice Address - Fax:464-777-8135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-21
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health