Provider Demographics
NPI:1235448002
Name:BENNETT, TERI LYNN (LPN)
Entity Type:Individual
Prefix:MS
First Name:TERI LYNN
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 CORLEY DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14622-1262
Mailing Address - Country:US
Mailing Address - Phone:585-278-6504
Mailing Address - Fax:585-319-3384
Practice Address - Street 1:69 CORLEY DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14622-1262
Practice Address - Country:US
Practice Address - Phone:585-278-6504
Practice Address - Fax:585-319-3384
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY180987164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse