Doctor Name: | MRS. THERESA DELORES BENNETT |
NPI Number: | 1497024541 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | 335938 |
Business Practice Address: | 110 Central Ave Box 70 Owego, NY - 138271311 |
Business Phone Number: | 6076875333 |
Business Fax Number: | 6076874899 |
Mailing Address: | 110 Central Ave, Box 70 OWEGO |
State: | NY |
Postal Code: | 138271311 |
Phone Number: | 6076875333 |
Fax Number: | 6076874899 |
NPI Enumeration Date: | 12/19/2011 |
NPI Last Update Date: | 12/19/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 335938 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |