Provider Demographics
NPI:1639450109
Name:BENNETT, STEFANIE L (APRN)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:L
Last Name:BENNETT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:STEFANIE
Other - Middle Name:L
Other - Last Name:SAMUELS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1823 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-3381
Mailing Address - Country:US
Mailing Address - Phone:785-776-2800
Mailing Address - Fax:785-565-4754
Practice Address - Street 1:1823 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-3381
Practice Address - Country:US
Practice Address - Phone:785-776-2800
Practice Address - Fax:785-565-4754
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS75473363L00000X
KS53-75473-121363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200743070AMedicaid
KS068002139OtherMEDICARE PTAN