Provider Demographics
NPI:1316203268
Name:BENNETT, SHAWNIA MARIE (RN)
Entity Type:Individual
Prefix:MS
First Name:SHAWNIA
Middle Name:MARIE
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 1:284 W WOODSIDE TER
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43528-8121
Mailing Address - Country:US
Mailing Address - Phone:419-208-0067
Mailing Address - Fax:
Practice Address - Street 1:284 W WOODSIDE TER
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-8121
Practice Address - Country:US
Practice Address - Phone:419-208-0067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN288833163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse