Provider Demographics
NPI:1205292067
Name:BENNETT, NATRAE
Entity type:Individual
Prefix:
First Name:NATRAE
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3543 JAY ST NE
Mailing Address - Street 2:102
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-1657
Mailing Address - Country:US
Mailing Address - Phone:301-640-0269
Mailing Address - Fax:
Practice Address - Street 1:3543 JAY ST NE
Practice Address - Street 2:102
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-1657
Practice Address - Country:US
Practice Address - Phone:301-640-0269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC11800374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide