| Benita Altidor, NP | |
|
101 N Lynnhaven Rd Ste 100, Virginia Beach, VA 23452-7523 | |
| (833) 510-4357 | |
| Not Available |
| Full Name | Benita Altidor |
|---|---|
| Gender | Female |
| Speciality | Nurse Practitioner - Acute Care |
| Location | 101 N Lynnhaven Rd Ste 100, Virginia Beach, Virginia |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194402073 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363LA2100X | Nurse Practitioner - Acute Care | 0024187421 (Virginia) | Primary |
| 363L00000X | Nurse Practitioner | 0024187421 (Virginia) | Secondary |
| Entity Name | Brightview Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1649786260 PECOS PAC ID: 9032426044 Enrollment ID: O20220401000078 |
| Mailing Address | Practice Location Address |
|---|---|
| Benita Altidor, NP 4600 Montgomery Rd Ste 400, Cincinnati, OH 45212-2600 Ph: (513) 873-1269 | Benita Altidor, NP 101 N Lynnhaven Rd Ste 100, Virginia Beach, VA 23452-7523 Ph: (833) 510-4357 |
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