Provider Demographics
NPI:1801820253
Name:BENNETT, DONNA S (MD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:S
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:DONNA
Other - Middle Name:
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:470 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-2346
Mailing Address - Country:US
Mailing Address - Phone:801-368-0575
Mailing Address - Fax:801-486-6061
Practice Address - Street 1:470 BROOKSIDE DR
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-2346
Practice Address - Country:US
Practice Address - Phone:801-368-0575
Practice Address - Fax:801-489-6061
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT188298-1205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist