Provider Demographics
NPI:1093143976
Name:BENNETT, SAHRA
Entity Type:Individual
Prefix:
First Name:SAHRA
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66441-4022
Mailing Address - Country:US
Mailing Address - Phone:785-492-9297
Mailing Address - Fax:
Practice Address - Street 1:915 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:JUNCTION CITY
Practice Address - State:KS
Practice Address - Zip Code:66441-4022
Practice Address - Country:US
Practice Address - Phone:785-492-9297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-31
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No253Z00000XAgenciesIn Home Supportive Care