Provider Demographics
NPI:1386189587
Name:BENNETT, REBECCA M (NP-C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:M
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 1:1100 REID PKWY
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-962-4872
Mailing Address - Fax:765-935-8913
Practice Address - Street 1:1911 CHESTER BLVD
Practice Address - Street 2:REID PLASTIC & RECONSTRUCTIVE SURGERY
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1212
Practice Address - Country:US
Practice Address - Phone:765-962-4872
Practice Address - Fax:765-935-8913
Is Sole Proprietor?:No
Enumeration Date:2016-12-23
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71006789A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily