Provider Demographics
NPI:1225295330
Name:BENNETT, ELIZABETH MULLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:MULLEN
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:ELIZABETH
Other - Middle Name:MULLEN
Other - Last Name:BENNETT-SOFIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:415 EVERWOOD CT NW
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-2602
Mailing Address - Country:US
Mailing Address - Phone:206-419-0089
Mailing Address - Fax:425-313-9533
Practice Address - Street 1:415 EVERWOOD CT NW
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2602
Practice Address - Country:US
Practice Address - Phone:206-419-0089
Practice Address - Fax:425-313-9533
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00033971207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine