Provider Demographics
NPI:1922667500
Name:BENNETT, HOLLY ELIZABETH (NP-C)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:ELIZABETH
Last Name:BENNETT
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:ELIZABETH
Other - Last Name:JEWELL-BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1450 TREAT BLVD # 300
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-2168
Mailing Address - Country:US
Mailing Address - Phone:925-952-2828
Mailing Address - Fax:
Practice Address - Street 1:1400 TREAT BLVD
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94597-2142
Practice Address - Country:US
Practice Address - Phone:925-947-4449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-07
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95010579363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily