Provider Demographics
NPI:1649082512
Name:BENNETT, THURDINA ROSE-MARIE (CNA)
Entity type:Individual
Prefix:MS
First Name:THURDINA
Middle Name:ROSE-MARIE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:734 SAINT OUEN ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10470-1380
Mailing Address - Country:US
Mailing Address - Phone:201-737-3586
Mailing Address - Fax:
Practice Address - Street 1:734 SAINT OUEN ST APT 1
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10470-1380
Practice Address - Country:US
Practice Address - Phone:201-737-3586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
314000000X
NYNY000435622E3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility