Provider Demographics
NPI:1558691964
Name:BENNETT, DEBRA L (RN)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:L
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 1:4951 RIDGEWOOD RD E
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-5943
Mailing Address - Country:US
Mailing Address - Phone:937-408-8352
Mailing Address - Fax:
Practice Address - Street 1:4951 RIDGEWOOD RD E
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-5943
Practice Address - Country:US
Practice Address - Phone:937-408-8352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN180600163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse