Provider Demographics
NPI:1801118468
Name:BENNETT, LYNNE MARIE (ARRT RM)
Entity type:Individual
Prefix:
First Name:LYNNE
Middle Name:MARIE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:ARRT RM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 PLEASANTON CT SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-3410
Mailing Address - Country:US
Mailing Address - Phone:360-350-0029
Mailing Address - Fax:
Practice Address - Street 1:2325 PLEASANTON CT SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-3410
Practice Address - Country:US
Practice Address - Phone:360-350-0029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
108238247100000X, 2471M2300X
CA00085109247100000X, 2471M2300X
WA60005660247100000X
OR105444247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
No2471M2300XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMammography