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General NPI Number Information
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NPI Number | 1538633656
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Entity Type | Individual
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Provider Name | SARAH ELIZABETH BENNETT MSN, AGPCNP-BC
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Gender | Female
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Dates
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Enumeration Date | 01/11/2019
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Last Update Date | 02/11/2020
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Provider Practice Location Address
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Address Line | 401 W POPLAR ST
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City | WALLA WALLA
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State | WA
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Zip | 99362-2846
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Country | US
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Telephone | 98-972-7005
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Fax | 509-897-5527
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Provider Business Mailing Address
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Address Line | 764 BRYANT AVE
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City | WALLA WALLA
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State | WA
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Zip | 99362-9322
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Country | US
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Telephone | 509-897-2715
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN61013768
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 225522
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | AP61017579
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 25407
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License Number State | TN
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Taxonomy #5
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | IP61031779
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License Number State | WA
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