Provider Demographics
NPI:1841267309
Name:NAVARRO, BENNETT (NP APRN)
Entity type:Individual
Prefix:MS
First Name:BENNETT
Middle Name:
Last Name:NAVARRO
Suffix:
Gender:F
Credentials:NP APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 328
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-0328
Mailing Address - Country:US
Mailing Address - Phone:801-979-5330
Mailing Address - Fax:801-446-7686
Practice Address - Street 1:12285 S 2240 W
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065
Practice Address - Country:US
Practice Address - Phone:801-979-5330
Practice Address - Fax:801-446-7686
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1966054405363LA2200X
UT1966058900363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
S41780Medicare UPIN