Provider Demographics
NPI:1700837663
Name:BENNETT, ELIZABETH RENEE (NP)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:RENEE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5999 PALOMINO DR
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18106-3600
Mailing Address - Country:US
Mailing Address - Phone:610-530-2677
Mailing Address - Fax:
Practice Address - Street 1:1517 POND RD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-2253
Practice Address - Country:US
Practice Address - Phone:610-395-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP006531B164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse