MEDICARE: TANESHA BENNETT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1538637467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANESHA BENNETT

Provider Business Mailing Address
First Line	:	31330 HIGHWAY 22 STE 101
Second Line	:
City	:	SPRINGFIELD
State	:	LA
Zip	:	70462-7427
Country	:	US
Telephone Number	:	225-294-7227
Fax Number	:

Provider Business Practice Location Address
First Line	:	31330 HIGHWAY 22 STE 101
Second Line	:
City	:	SPRINGFIELD
State	:	LA
Zip	:	70462-7427
Country	:	US
Telephone Number	:	225-294-7227
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2018
Last Update Date	:	11/08/2018

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Directions to “ TANESHA BENNETT ” Practice Location

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