Healthcare Provider Details

I. General information

NPI: 1538633656
Provider Name (Legal Business Name): SARAH ELIZABETH BENNETT MSN, AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. SARAH ELIZABETH BRIGHT

II. Dates (important events)

Enumeration Date: 01/11/2019
Last Update Date: 02/11/2020
Certification Date: 02/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W POPLAR ST
WALLA WALLA WA
99362-2846
US

IV. Provider business mailing address

764 BRYANT AVE
WALLA WALLA WA
99362-9322
US

V. Phone/Fax

Practice location:
  • Phone: 98-972-7005
  • Fax: 509-897-5527
Mailing address:
  • Phone: 509-897-2715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN61013768
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number225522
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP61017579
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number25407
License Number StateTN
# 5
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberIP61031779
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: