MEDICARE: MISS CHEVELLE ANTIONETTE BENNETT NURSE (LPN)

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	PN.160731.M-IV	OH

General Provider Information

NPI Number	:	1013406040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS CHEVELLE ANTIONETTE BENNETT NURSE (LPN)

Provider Business Mailing Address
First Line	:	4964 SPRINGBORO PIKE
Second Line	:
City	:	MORAINE
State	:	OH
Zip	:	45439-1940
Country	:	US
Telephone Number	:	937-949-8716
Fax Number	:	937-834-4446

Provider Business Practice Location Address
First Line	:	4964 SPRINGBORO PIKE
Second Line	:
City	:	MORAINE
State	:	OH
Zip	:	45439-1940
Country	:	US
Telephone Number	:	937-856-9576
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2018
Last Update Date	:	04/07/2026

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Directions to “ MISS CHEVELLE ANTIONETTE BENNETT NURSE (LPN)” Practice Location

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