Provider Demographics
NPI:1467776658
Name:BENNETT, PATRICIA JANE (RN BSN)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:JANE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 MOHICAN LN
Mailing Address - Street 2:
Mailing Address - City:PATASKALA
Mailing Address - State:OH
Mailing Address - Zip Code:43062-8156
Mailing Address - Country:US
Mailing Address - Phone:740-964-3218
Mailing Address - Fax:
Practice Address - Street 1:161 MOHICAN LN
Practice Address - Street 2:
Practice Address - City:PATASKALA
Practice Address - State:OH
Practice Address - Zip Code:43062-8156
Practice Address - Country:US
Practice Address - Phone:740-964-3218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.204362163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse