Individual
JORDAN BENAVIDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2360 E PERSHING BLVD, CHEYENNE, WY 82001-5356
(307) 778-7358
Mailing address
532 MARK RD, CHEYENNE, WY 82007-9694
(307) 286-6845
Taxonomy
Speciality
Code
Description
License number
State
163WA2000X
Administrator Registered Nurse
Primary
33219
WY
Other
Enumeration date
10/24/2024
Last updated
10/24/2024
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