Provider Demographics
NPI:1245424662
Name:BENNETT, TERRY RENEE
Entity Type:Individual
Prefix:MRS
First Name:TERRY
Middle Name:RENEE
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 1:83 SURREY DRIVE
Mailing Address - Street 2:
Mailing Address - City:CENTER MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11934-2819
Mailing Address - Country:US
Mailing Address - Phone:631-878-6131
Mailing Address - Fax:
Practice Address - Street 1:18 BEAVER LANE WEST
Practice Address - Street 2:
Practice Address - City:WESTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11977-1201
Practice Address - Country:US
Practice Address - Phone:631-288-3210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY152625 1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse