Provider Demographics
NPI:1932614724
Name:BENNETT, DARLENE SHANEA (STNA)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:SHANEA
Last Name:BENNETT
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11725 HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44105-5437
Mailing Address - Country:US
Mailing Address - Phone:216-855-7275
Mailing Address - Fax:
Practice Address - Street 1:11725 HARVARD AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44105-5437
Practice Address - Country:US
Practice Address - Phone:216-855-7275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-04
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401031200110376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide