Healthcare Provider Details

I. General information

NPI: 1629814413
Provider Name (Legal Business Name): DENA BENNETT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DENA KAUFMAN

II. Dates (important events)

Enumeration Date: 07/02/2024
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 N PINES RD # A
SPOKANE VALLEY WA
99206-4942
US

IV. Provider business mailing address

969 STEVENS DR STE 3A
RICHLAND WA
99352-3558
US

V. Phone/Fax

Practice location:
  • Phone: 509-713-1315
  • Fax: 877-673-0795
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP61563375
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP61563375
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: