Provider Demographics
NPI:1427601236
Name:BENNETT, MICHAEL DARYL (RN)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DARYL
Last Name:BENNETT
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 LEI LANI DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-3021
Mailing Address - Country:US
Mailing Address - Phone:615-714-7783
Mailing Address - Fax:
Practice Address - Street 1:100 W BURTON ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-3657
Practice Address - Country:US
Practice Address - Phone:615-898-7880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-21
Last Update Date:2019-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN215282163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse