Individual
ANNABELLE L BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1716 HARTFORD ST, LAFAYETTE, IN 47904-2173
(765) 742-1567
(765) 429-6961
Mailing address
1716 HARTFORD ST, LAFAYETTE, IN 47904-2173
(765) 742-1567
(765) 429-6961
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
71002238A
IN
363LP0200X
Pediatric Nurse Practitioner
Primary
71002238A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2008455550
—
IN
01
—
71002238A
ST. LICENSE
IN
Enumeration date
02/08/2007
Last updated
11/07/2011
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