Healthcare Provider Details

I. General information

NPI: 1831010578
Provider Name (Legal Business Name): TAYLOR LEE BENNETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 N THOMPSON LN STE E
IRWIN PA
15642-9305
US

IV. Provider business mailing address

25 N THOMPSON LN STE E
IRWIN PA
15642-9305
US

V. Phone/Fax

Practice location:
  • Phone: 724-382-4941
  • Fax: 724-590-5121
Mailing address:
  • Phone: 724-382-4941
  • Fax: 724-590-5121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP036459
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: