Provider Demographics
NPI:1881305498
Name:BENNETT, RAYNELL (RN)
Entity type:Individual
Prefix:MS
First Name:RAYNELL
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4003 CHATHAM RD
Mailing Address - Street 2:
Mailing Address - City:GWYNN OAK
Mailing Address - State:MD
Mailing Address - Zip Code:21207-7614
Mailing Address - Country:US
Mailing Address - Phone:443-889-2800
Mailing Address - Fax:
Practice Address - Street 1:4003 CHATHAM RD
Practice Address - Street 2:
Practice Address - City:GWYNN OAK
Practice Address - State:MD
Practice Address - Zip Code:21207-7614
Practice Address - Country:US
Practice Address - Phone:443-889-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR242494163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse