Provider Demographics
NPI:1871852814
Name:BENNETT, VALENTINE COLLEEN
Entity Type:Individual
Prefix:
First Name:VALENTINE
Middle Name:COLLEEN
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 1:5119 FITCH ST SE APT 101
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-5924
Mailing Address - Country:US
Mailing Address - Phone:202-604-4589
Mailing Address - Fax:
Practice Address - Street 1:5119 FITCH ST SE APT 101
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-5924
Practice Address - Country:US
Practice Address - Phone:202-604-4589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1569953374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide