Healthcare Provider Details

I. General information

NPI: 1841273950
Provider Name (Legal Business Name): VELVA C BENNETT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VELVIE C BENNETT NP

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 02/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 24TH ST
FORT LEE VA
23801-1716
US

IV. Provider business mailing address

700 24TH ST
FORT LEE VA
23801-1716
US

V. Phone/Fax

Practice location:
  • Phone: 804-734-9993
  • Fax: 804-734-9312
Mailing address:
  • Phone: 804-734-9993
  • Fax: 804-734-9312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number0024165890
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024165890
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: