Individual
ELIZABETH EMILY BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
975 S FAIRMONT AVE, LODI, CA 95240-5118
(209) 333-3135
Mailing address
500 N FAIRMONT AVE, LODI, CA 95240-1614
(209) 712-6531
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
812638
CA
363LF0000X
Family Nurse Practitioner
Primary
NP95010098
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NP95010098
CALIFORNIA BOARD OF REGISTERED NURSING
CA
Enumeration date
10/24/2018
Last updated
06/20/2019
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