Provider Demographics
NPI:1134382492
Name:WILSON-BENNETT, RENEE LYNETTE (FNP)
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:LYNETTE
Last Name:WILSON-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 1:22319 MURDOCK AVE
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11429-2726
Mailing Address - Country:US
Mailing Address - Phone:718-527-2328
Mailing Address - Fax:718-527-2328
Practice Address - Street 1:200 MOTOR PKWY STE D22
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-5116
Practice Address - Country:US
Practice Address - Phone:631-273-1258
Practice Address - Fax:631-273-1264
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF335386-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily