Provider Demographics
NPI:1518102698
Name:BENNETT, ANNETTE D (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ANNETTE
Middle Name:D
Last Name:BENNETT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1061 E MAIN ST
Mailing Address - Street 2:STE 204
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5724
Mailing Address - Country:US
Mailing Address - Phone:530-274-2274
Mailing Address - Fax:530-274-2559
Practice Address - Street 1:1061 E MAIN ST
Practice Address - Street 2:STE 204
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5724
Practice Address - Country:US
Practice Address - Phone:530-274-2274
Practice Address - Fax:530-274-2559
Is Sole Proprietor?:No
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA11955363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical