Provider Demographics
NPI:1740306083
Name:BENNETT, ELEANOR E
Entity type:Individual
Prefix:MRS
First Name:ELEANOR
Middle Name:E
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 1:1460 MIMOSA DRIVE
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79603
Mailing Address - Country:US
Mailing Address - Phone:325-672-1403
Mailing Address - Fax:
Practice Address - Street 1:1460 MIMOSA DRIVE
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79603
Practice Address - Country:US
Practice Address - Phone:325-672-1403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant