Individual
LISA M BENEDETTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
132 INDIAN CREEK RD, ITHACA, NY 14850-1331
(607) 379-9606
(607) 821-4374
Mailing address
132 INDIAN CREEK RD, ITHACA, NY 14850-1331
(607) 379-9606
(607) 821-4374
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
171868
CO
367A00000X
Advanced Practice Midwife
13010
CO
367A00000X
Advanced Practice Midwife
Primary
F00149-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
26371243
—
CO
Enumeration date
03/26/2010
Last updated
05/16/2020
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