Provider Demographics
NPI:1699197004
Name:BENNETT, ERESHA CAROLYN (WHNP-BC)
Entity Type:Individual
Prefix:
First Name:ERESHA
Middle Name:CAROLYN
Last Name:BENNETT
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:MRS
Other - First Name:ERESHA
Other - Middle Name:CAROLYN
Other - Last Name:BRATHWAITE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:738 DREW ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-4205
Mailing Address - Country:US
Mailing Address - Phone:347-320-5017
Mailing Address - Fax:
Practice Address - Street 1:1 GUSTAVE L LEVY PL FL 12
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6574
Practice Address - Country:US
Practice Address - Phone:212-241-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-21
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY675616163W00000X
NY421409363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse