Provider Demographics
NPI:1568751709
Name:BENNETT, TAMMIE RENEE (LVN)
Entity Type:Individual
Prefix:MRS
First Name:TAMMIE
Middle Name:RENEE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8413 EUCALYPTUS AVE
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:93505-3221
Mailing Address - Country:US
Mailing Address - Phone:760-373-3908
Mailing Address - Fax:760-373-3908
Practice Address - Street 1:8413 EUCALYPTUS AVE
Practice Address - Street 2:
Practice Address - City:CALIFORNIA CITY
Practice Address - State:CA
Practice Address - Zip Code:93505-3221
Practice Address - Country:US
Practice Address - Phone:760-373-3908
Practice Address - Fax:760-373-3908
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 187144164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse