Healthcare Provider Details

I. General information

NPI: 1376778340
Provider Name (Legal Business Name): ELIZABETH N BENNETT CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2009
Last Update Date: 05/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 W SCHOOL HOUSE LN
PHILADELPHIA PA
19144-3348
US

IV. Provider business mailing address

185 MANSION RD
NEWTOWN SQUARE PA
19073-3406
US

V. Phone/Fax

Practice location:
  • Phone: 215-844-8806
  • Fax:
Mailing address:
  • Phone: 610-356-8086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberSP0005387H
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: