Provider Demographics
NPI:1346763059
Name:BENNETT, LELLA
Entity Type:Individual
Prefix:
First Name:LELLA
Middle Name:
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 1:24011 PEPPERRELL PLACE ST
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-2608
Mailing Address - Country:US
Mailing Address - Phone:832-371-3425
Mailing Address - Fax:
Practice Address - Street 1:24011 PEPPERRELL PLACE
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493
Practice Address - Country:US
Practice Address - Phone:832-371-3425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty