Healthcare Provider Details

I. General information

NPI: 1427504042
Provider Name (Legal Business Name): CATHERINE BENNETT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 02/05/2021
Certification Date: 02/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 MEMORIAL DR SUITE 200
BELLEVILLE IL
62226-5368
US

IV. Provider business mailing address

4500 MEMORIAL DRIVE MEMORIAL HOSPITAL CREDENTIALING DEPARTMENT
BELLEVILLE IL
62226
US

V. Phone/Fax

Practice location:
  • Phone: 618-233-2220
  • Fax: 618-233-2555
Mailing address:
  • Phone: 618-257-4644
  • Fax: 618-257-6946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209014539
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: