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Individual

KYLE C BENEDETTO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CRNA

Contact information

Practice address
1200 S CEDAR CREST BLVD, ALLENTOWN, PA 18103-6202
(610) 402-9099
(610) 402-9029
Mailing address
1245 S CEDAR CREST BLVD STE 301, ALLENTOWN, PA 18103-6258
(610) 402-9099
(610) 402-9029

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN-514873-L
PA
367500000X
Certified Registered Nurse Anesthetist
Primary
079367
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1027799960001
PA
01
113550
GEISINGER
PA
01
11879379
CAQH
PA
01
1579509
GATEWAY
PA
01
2003657
FIRST PRIORITY
PA
01
3421325000
INDEPENDENCE BLUE CROSS
PA
01
50073814
CAPITAL ADVANTAGE
PA
01
9057432
AETNA
PA
Enumeration date
12/07/2007
Last updated
03/25/2013
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