Provider Demographics
NPI:1740511443
Name:BENNETT, KASSANDRA (LPN)
Entity type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N3588 COUNTY ROAD J
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54653-9535
Mailing Address - Country:US
Mailing Address - Phone:608-792-5855
Mailing Address - Fax:608-486-2916
Practice Address - Street 1:N3588 COUNTY ROAD J
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:WI
Practice Address - Zip Code:54653-9535
Practice Address - Country:US
Practice Address - Phone:608-792-5855
Practice Address - Fax:608-486-2916
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI311917-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse