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NPI Code Detail

MEDICARE: MS. NIA BENNETT LPN

MEDICARE: MS. NIA BENNETT 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
1164W00000XLicensed Practical NursePN238870PA

General Provider Information

NPI Number : 1447750526
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. NIA BENNETT LPN
Provider Business Mailing Address
First Line : 1804 ASHLEY ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19126-1515
Country : US
Telephone Number : 267-565-0633
Fax Number :
Provider Business Practice Location Address
First Line : 5500 TABOR AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19120-2124
Country : US
Telephone Number : 215-245-2131
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2018
Last Update Date : 02/15/2018

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