Individual
DANA BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LVN
Contact information
Practice address
828 CROCKETT ST, PLEASANTON, TX 78064-2824
(912) 816-7452
Mailing address
828 CROCKETT ST, PLEASANTON, TX 78064-2824
(912) 816-7452
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
331484
TX
Other
Enumeration date
05/14/2019
Last updated
05/14/2019
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