Provider Demographics
NPI:1891942447
Name:BENNETT, JOHSIE M (NP)
Entity Type:Individual
Prefix:
First Name:JOHSIE
Middle Name:M
Last Name:BENNETT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JOHSIE
Other - Middle Name:M
Other - Last Name:OLIVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:974 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:WEARE
Mailing Address - State:NH
Mailing Address - Zip Code:03281-5216
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:974 RIVER RD
Practice Address - Street 2:
Practice Address - City:WEARE
Practice Address - State:NH
Practice Address - Zip Code:03281-5216
Practice Address - Country:US
Practice Address - Phone:978-235-4951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH075277-23363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0721310Medicaid