Provider Demographics
NPI:1558403865
Name:BENNETT, GLENDA (RN)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:662 LARKSPUR LN
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-8320
Mailing Address - Country:US
Mailing Address - Phone:970-245-4412
Mailing Address - Fax:
Practice Address - Street 1:2800 D RD
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-4721
Practice Address - Country:US
Practice Address - Phone:970-255-5818
Practice Address - Fax:970-255-5830
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN-56921163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator