Provider Demographics
NPI:1689427783
Name:BENNETT, THERESA MICHELLE (RN)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:MICHELLE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9452 TELEPHONE RD STE 121
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93004-2600
Mailing Address - Country:US
Mailing Address - Phone:805-350-3839
Mailing Address - Fax:
Practice Address - Street 1:9452 TELEPHONE RD STE 121
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93004-2600
Practice Address - Country:US
Practice Address - Phone:805-350-3839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider