Provider Demographics
NPI:1225922735
Name:BENNETT, MARY SUSAN (RN, BSN, PHN,)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:SUSAN
Last Name:BENNETT
Suffix:
Gender:F
Credentials:RN, BSN, PHN,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8549 ELM CIR
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-4031
Mailing Address - Country:US
Mailing Address - Phone:714-315-2020
Mailing Address - Fax:
Practice Address - Street 1:8549 ELM CIR
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-4031
Practice Address - Country:US
Practice Address - Phone:714-315-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-07
Last Update Date:2025-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA319716163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse