MEDICARE: RACHEAL BENNETT APRN-CNP

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	363LA2200X	Adult Health Nurse Practitioner	APRN.CNP.0035338	OH
2	363LG0600X	Gerontology Nurse Practitioner	APRN.CNP.0035338	OH
3	363LP2300X	Primary Care Nurse Practitioner	APRN.CNP.0035338	OH

General Provider Information

NPI Number	:	1922872282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEAL BENNETT APRN-CNP

Provider Business Mailing Address
First Line	:	5017 NOBLES POND DR NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44718-3802
Country	:	US
Telephone Number	:	330-324-0715
Fax Number	:

Provider Business Practice Location Address
First Line	:	4634 HILLS AND DALES RD NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44708-1510
Country	:	US
Telephone Number	:	330-477-0255
Fax Number	:

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

Provider Enumeration Date	:	11/08/2023
Last Update Date	:	02/09/2026

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