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Individual

SHIRLEEN BENNETT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RN

Contact information

Practice address
76 VETERANS AVE, BATH, NY 14810-0810
(585) 297-3791
Mailing address
377 PACKWOOD RD, WATERLOO, NY 13165-9720
(315) 857-3875

Taxonomy

Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
467644-1
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
467644-1
NURSING REGISTRATION
NY
Enumeration date
09/25/2019
Last updated
09/25/2019
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