Provider Demographics
NPI:1225255441
Name:BENNETT, MARY ANN (RN)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ANN
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 1:5442 REIGHMOOR RD
Mailing Address - Street 2:
Mailing Address - City:OMRO
Mailing Address - State:WI
Mailing Address - Zip Code:54963-9438
Mailing Address - Country:US
Mailing Address - Phone:920-203-1877
Mailing Address - Fax:
Practice Address - Street 1:5442 REIGHMOOR RD
Practice Address - Street 2:
Practice Address - City:OMRO
Practice Address - State:WI
Practice Address - Zip Code:54963-9438
Practice Address - Country:US
Practice Address - Phone:920-203-1877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse