Individual
MRS. LYNN PHYLLIS BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
11587 LAUREL LAKE SQ, FAIRFAX, VA 22030-6074
(571) 224-5426
Mailing address
11587 LAUREL LAKE SQ, FAIRFAX, VA 22030-6074
(571) 224-5426
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
0001105791
VA
Other
Enumeration date
06/19/2012
Last updated
06/19/2012
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