Provider Demographics
NPI:1265779714
Name:BENNETT, ANNA M (CST)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:M
Last Name:BENNETT
Suffix:
Gender:F
Credentials:CST
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:14001 RIDGEDALE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-1753
Mailing Address - Country:US
Mailing Address - Phone:952-249-2000
Mailing Address - Fax:952-249-2099
Practice Address - Street 1:14001 RIDGEDALE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1753
Practice Address - Country:US
Practice Address - Phone:952-249-2000
Practice Address - Fax:952-249-2099
Is Sole Proprietor?:No
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN127229246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant