Provider Demographics
NPI:1679931976
Name:BENT, YVONNE M (LPN)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:M
Last Name:BENT
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 1:162 W 122ND ST # L
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-5553
Mailing Address - Country:US
Mailing Address - Phone:917-993-0069
Mailing Address - Fax:
Practice Address - Street 1:162 W 122ND ST # L
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-5553
Practice Address - Country:US
Practice Address - Phone:917-993-0069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204175-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse