Healthcare Provider Details

I. General information

NPI: 1619190212
Provider Name (Legal Business Name): VIRGINIA H BENNETT CNS, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GINNY BENNETT CLINICAL NURSE SPECI

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 EAST CENTER ST
MANCHESTER CT
06040
US

IV. Provider business mailing address

P.O BOX 1072
MANCHESTER CT
06045
US

V. Phone/Fax

Practice location:
  • Phone: 860-647-1582
  • Fax: 860-647-1582
Mailing address:
  • Phone: 860-647-1582
  • Fax: 860-647-1585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number00173
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number0281025-01
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number001713
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: