Provider Demographics
NPI:1376767590
Name:BENNETT, SANDRA O (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:O
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:PO DRAWER 12610
Mailing Address - Street 2:2818 NEUSE BLVD.
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28561
Mailing Address - Country:US
Mailing Address - Phone:252-636-4920
Mailing Address - Fax:252-636-4970
Practice Address - Street 1:2818 NEUSE BLVD.
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28561-2610
Practice Address - Country:US
Practice Address - Phone:252-636-4920
Practice Address - Fax:252-636-4970
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC800115363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
592551Medicare UPIN