Healthcare Provider Details

I. General information

NPI: 1366228934
Provider Name (Legal Business Name): MARIANNE BENNETT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2023
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 MAIN ST
DUNCAN AZ
85534-9701
US

IV. Provider business mailing address

331 N HUNT DR E
MESA AZ
85203-8126
US

V. Phone/Fax

Practice location:
  • Phone: 928-359-1380
  • Fax: 928-359-1381
Mailing address:
  • Phone: 207-522-7511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number295734
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: