Provider Demographics
NPI:1922659465
Name:BENNETT, MONICA D (LPN)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:D
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 NORA ST
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-6843
Mailing Address - Country:US
Mailing Address - Phone:304-699-9114
Mailing Address - Fax:
Practice Address - Street 1:812 3RD ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-1803
Practice Address - Country:US
Practice Address - Phone:740-371-5476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV31840164W00000X
OH172273164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH172273OtherOH NURSING LICENSE