Provider Demographics
NPI:1376973057
Name:BENNDALE ELEMENTARY SCHOOL
Entity Type:Organization
Organization Name:BENNDALE ELEMENTARY SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SCHOOL NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:JODI
Authorized Official - Middle Name:THERESA
Authorized Official - Last Name:SUMRALL
Authorized Official - Suffix:
Authorized Official - Credentials:RN, ADN
Authorized Official - Phone:601-947-6993
Mailing Address - Street 1:5204 HIGHWAY 26 W
Mailing Address - Street 2:
Mailing Address - City:LUCEDALE
Mailing Address - State:MS
Mailing Address - Zip Code:39452-2383
Mailing Address - Country:US
Mailing Address - Phone:601-766-6341
Mailing Address - Fax:601-945-2938
Practice Address - Street 1:5204 HIGHWAY 26 W
Practice Address - Street 2:
Practice Address - City:LUCEDALE
Practice Address - State:MS
Practice Address - Zip Code:39452-2383
Practice Address - Country:US
Practice Address - Phone:601-766-6341
Practice Address - Fax:601-945-2938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR872149390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty