Provider Demographics
NPI:1356467989
Name:BENNETT, MARY JANE (NP-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JANE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 S PEORIA ST
Mailing Address - Street 2:100
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-5476
Mailing Address - Country:US
Mailing Address - Phone:303-306-4321
Mailing Address - Fax:303-306-4347
Practice Address - Street 1:2400 S PEORIA ST
Practice Address - Street 2:100
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-5476
Practice Address - Country:US
Practice Address - Phone:303-306-4321
Practice Address - Fax:303-306-4347
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2017-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0005294363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
009269OtherKAISER-COMMERCIAL NUMBER