Provider Demographics
NPI:1083391239
Name:BENNETT, GARRETT FRANK
Entity Type:Individual
Prefix:
First Name:GARRETT
Middle Name:FRANK
Last Name:BENNETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 1ST AVE NW
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58703-3006
Mailing Address - Country:US
Mailing Address - Phone:701-527-0525
Mailing Address - Fax:
Practice Address - Street 1:2945 HIGHWAY 25
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-8002
Practice Address - Country:US
Practice Address - Phone:701-527-0524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant