Individual
MS. LAVERNE ZETA BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN,MSN, PMHNP
Contact information
Practice address
769 W BLAINE ST, RIVERSIDE, CA 92507-3970
(951) 358-4523
Mailing address
769 W BLAINE ST, RIVERSIDE, CA 92507-3970
(951) 358-4523
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
19932
CA
Other
Enumeration date
10/16/2013
Last updated
10/16/2013
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