Provider Demographics
NPI:1326398397
Name:BENNETT, STEPHANIE L (RN)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:L
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 1:1684 ARTHUR ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-3426
Mailing Address - Country:US
Mailing Address - Phone:541-232-7817
Mailing Address - Fax:
Practice Address - Street 1:1684 ARTHUR ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-3426
Practice Address - Country:US
Practice Address - Phone:541-232-7817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR091007366RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse