MEDICARE: MRS. STEPHANIE J BENNETT ARNP

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	363L00000X	Nurse Practitioner	AP30005581	WA
2	363LF0000X	Family Nurse Practitioner	AP30005581	WA

General Provider Information

NPI Number	:	1376536706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHANIE J BENNETT ARNP

Provider Business Mailing Address
First Line	:	1012 SOUTH THIRD STREET
Second Line	:
City	:	DAYTON
State	:	WA
Zip	:	99328
Country	:	US
Telephone Number	:	503-413-3900
Fax Number	:

Provider Business Practice Location Address
First Line	:	295 SOUTH COLLEGE AVE. SUITE 1
Second Line	:
City	:	COLLEGE PLACE
State	:	WA
Zip	:	99324
Country	:	US
Telephone Number	:	509-382-8349
Fax Number	:	509-593-4342

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

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	10/17/2022

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