Provider Demographics
NPI:1881294759
Name:BENNETT, STEVEN H
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:H
Last Name:BENNETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2945 HIGHWAY 25
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-8002
Mailing Address - Country:US
Mailing Address - Phone:701-989-8162
Mailing Address - Fax:
Practice Address - Street 1:2945 HIGHWAY 25
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-8002
Practice Address - Country:US
Practice Address - Phone:701-663-8937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant