Provider Demographics
NPI:1720557838
Name:BENNETT, BRITTANY IESHA
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:IESHA
Last Name:BENNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12301 TREETOP DR APT 44
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-7661
Mailing Address - Country:US
Mailing Address - Phone:202-817-1690
Mailing Address - Fax:
Practice Address - Street 1:12301 TREETOP DR APT 44
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-7661
Practice Address - Country:US
Practice Address - Phone:202-817-1690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant