Provider Demographics
NPI:1932987112
Name:BENNETT, JANIE F
Entity Type:Individual
Prefix:
First Name:JANIE
Middle Name:F
Last Name:BENNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANIE
Other - Middle Name:F
Other - Last Name:COOKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:695 MOUNTAINEER HWY
Mailing Address - Street 2:
Mailing Address - City:MULLENS
Mailing Address - State:WV
Mailing Address - Zip Code:25882-0255
Mailing Address - Country:US
Mailing Address - Phone:304-294-8800
Mailing Address - Fax:
Practice Address - Street 1:695 MOUNTAINEER HWY
Practice Address - Street 2:
Practice Address - City:MULLENS
Practice Address - State:WV
Practice Address - Zip Code:25882-0255
Practice Address - Country:US
Practice Address - Phone:304-294-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant