Provider Demographics
NPI:1043630338
Name:BENNETT, DENISE E (RN)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:E
Last Name:BENNETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 VERONICA WAY
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-1854
Mailing Address - Country:US
Mailing Address - Phone:815-219-0685
Mailing Address - Fax:
Practice Address - Street 1:103 VERONICA WAY
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-1854
Practice Address - Country:US
Practice Address - Phone:815-219-0685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-24
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041293888163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse