Individual
MRS. MARVA LOUISE BENNETT-WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
REGISTERED NURSE
Contact information
Practice address
7188 S US #1, PORT SAINT LUCIE, FL 34952
(772) 301-1274
(772) 301-1387
Mailing address
7188 S US #1, PORT SAINT LUCIE, FL 34952
(772) 301-1274
(772) 301-1387
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN9389778
FL
164W00000X
Licensed Practical Nurse
PN5157934
FL
251E00000X
Home Health Agency
—
—
251F00000X
Home Infusion Agency
—
—
251J00000X
Nursing Care Agency
Primary
RN9389778
FL
253Z00000X
In Home Supportive Care Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
014818700
—
FL
05
—
019161900
—
FL
Enumeration date
04/04/2007
Last updated
05/03/2017
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