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NPI Code Detail

MEDICARE: ROSE MARY BENNETT RN

MEDICARE: ROSE MARY BENNETT RN
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
1163W00000XRegistered Nurse226700TX

General Provider Information

NPI Number : 1851706162
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROSE MARY BENNETT RN
Provider Business Mailing Address
First Line : 1101 S MAIN ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-4802
Country : US
Telephone Number : 817-321-4717
Fax Number : 817-548-3997
Provider Business Practice Location Address
First Line : 536 W RANDOL MILL RD
Second Line :
City : ARLINGTON
State : TX
Zip : 76011-5738
Country : US
Telephone Number : 817-321-4717
Fax Number : 817-548-3997
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2014
Last Update Date : 06/25/2014

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