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General NPI Number Information
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NPI Number | 1093368433
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Entity Type | Individual
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Provider Name | JESSICA SOPHIA BENNETT BSN, SRNA
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Gender | Female
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Dates
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Enumeration Date | 07/23/2019
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Last Update Date | 04/04/2022
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Provider Practice Location Address
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Address Line | 101 MANNING DR
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City | CHAPEL HILL
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State | NC
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Zip | 27514-4220
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Country | US
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Telephone | 984-974-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 424 HERITAGE VILLAGE LN
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City | APEX
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State | NC
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Zip | 27502-8492
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Country | US
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Telephone | 919-606-8289
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 270909
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License Number State | NC
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