Provider Demographics
NPI:1891198784
Name:BENNETT, GENEVIEVE (FNP)
Entity Type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 SENTARA CIR STE 450
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-5725
Mailing Address - Country:US
Mailing Address - Phone:757-345-4600
Mailing Address - Fax:
Practice Address - Street 1:400 SENTARA CIR STE 450
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-5725
Practice Address - Country:US
Practice Address - Phone:757-345-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-06
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024172109363LF0000X, 363LF0000X
GARN257467363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily