Provider Demographics
NPI:1457506982
Name:BENNETT, DELORES ARDITH ELENA (LPN)
Entity Type:Individual
Prefix:
First Name:DELORES
Middle Name:ARDITH ELENA
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10448 W FLORISSANT AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-2343
Mailing Address - Country:US
Mailing Address - Phone:314-867-8865
Mailing Address - Fax:314-867-8079
Practice Address - Street 1:10448 W FLORISSANT AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-2343
Practice Address - Country:US
Practice Address - Phone:314-867-8865
Practice Address - Fax:314-867-8079
Is Sole Proprietor?:No
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO026190164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse