Provider Demographics
NPI:1598904823
Name:BENNETT, ADDONCOLIA DONNA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ADDONCOLIA
Middle Name:DONNA
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 FOLKER ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5321
Mailing Address - Country:US
Mailing Address - Phone:907-261-5551
Mailing Address - Fax:907-561-1416
Practice Address - Street 1:4020 FOLKER ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5321
Practice Address - Country:US
Practice Address - Phone:907-261-5551
Practice Address - Fax:907-561-1416
Is Sole Proprietor?:No
Enumeration Date:2009-02-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK6494164W00000X
SCP39597164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse