Provider Demographics
NPI:1912470519
Name:BENNETT, BRESHELLE (FNP)
Entity Type:Individual
Prefix:
First Name:BRESHELLE
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LETHBRIDGE PLZ STE 20
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-2114
Mailing Address - Country:US
Mailing Address - Phone:609-474-0120
Mailing Address - Fax:609-474-0121
Practice Address - Street 1:137 HIGH ST FL 2A
Practice Address - Street 2:
Practice Address - City:MOUNT HOLLY
Practice Address - State:NJ
Practice Address - Zip Code:08060-1476
Practice Address - Country:US
Practice Address - Phone:609-474-0120
Practice Address - Fax:609-474-0121
Is Sole Proprietor?:No
Enumeration Date:2019-01-07
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00890800363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily