Provider Demographics
NPI:1003688961
Name:BENNETT, GRETCHEN A (RN, BSN)
Entity Type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:A
Last Name:BENNETT
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 MOLLY MARIE AVE
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-7793
Mailing Address - Country:US
Mailing Address - Phone:206-713-9060
Mailing Address - Fax:
Practice Address - Street 1:1602 MOLLY MARIE AVE
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-7793
Practice Address - Country:US
Practice Address - Phone:206-713-9060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00147856163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health