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NPI Code Detail

MEDICARE: MARY JANE BENNETT NP-C

MEDICARE: MARY JANE BENNETT NP-C
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
1363LF0000XFamily Nurse PractitionerA10235AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1009269OTHERKAISER-COMMERCIAL NUMBER

General Provider Information

NPI Number : 1356467989
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY JANE BENNETT NP-C
Provider Business Mailing Address
First Line : 2415 E CAMELBACK RD STE 700
Second Line :
City : PHOENIX
State : AZ
Zip : 85016-4245
Country : US
Telephone Number : 520-246-3971
Fax Number : 833-450-4452
Provider Business Practice Location Address
First Line : 2415 E CAMELBACK RD STE 700
Second Line :
City : PHOENIX
State : AZ
Zip : 85016-4245
Country : US
Telephone Number : 520-246-3971
Fax Number : 833-450-4452
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2007
Last Update Date : 06/05/2024

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Directions to “ MARY JANE BENNETT NP-C” Practice Location

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