Provider Demographics
NPI:1619214087
Name:BENNETT, ROBERT DAVID (LPN)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:DAVID
Last Name:BENNETT
Suffix:
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 1:6162 HOLLYBERRY LN
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-5194
Mailing Address - Country:US
Mailing Address - Phone:513-549-6227
Mailing Address - Fax:513-737-1533
Practice Address - Street 1:6162 HOLLYBERRY LN
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-5194
Practice Address - Country:US
Practice Address - Phone:513-549-6227
Practice Address - Fax:513-737-1533
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-05
Last Update Date:2013-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-105822164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse