Provider Demographics
NPI:1912660655
Name:BENNETT, SHELLEY K
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:K
Last Name:BENNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 PARKVIEW DR LOT 5
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-1319
Mailing Address - Country:US
Mailing Address - Phone:419-601-8434
Mailing Address - Fax:
Practice Address - Street 1:315 PARKVIEW DR LOT 5
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-1319
Practice Address - Country:US
Practice Address - Phone:419-601-8434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No347C00000XTransportation ServicesPrivate Vehicle
No374U00000XNursing Service Related ProvidersHome Health Aide