Individual
LATYEASARAL MONQUELLA BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
7845 LITTLE AVE, CHARLOTTE, NC 28226-8198
(704) 375-0100
Mailing address
607 S GENERALS BLVD, LINCOLNTON, NC 28092-3658
(704) 736-9188
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
5008577
NC
Other
Enumeration date
05/25/2016
Last updated
09/03/2019
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