Provider Demographics
NPI:1578972220
Name:BENNETT, ALBERT II (LPN)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:
Last Name:BENNETT
Suffix:II
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:556 WELLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14619-1852
Mailing Address - Country:US
Mailing Address - Phone:585-967-5735
Mailing Address - Fax:
Practice Address - Street 1:556 WELLINGTON AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14619-1852
Practice Address - Country:US
Practice Address - Phone:585-967-5735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY312264164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse