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Individual

EBONIQUE T BENNETT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
10 SAINT PATRICKS DR, WALDORF, MD 20603-4527
(301) 373-7900
(301) 373-6900
Mailing address
10 SAINT PATRICKS DR, WALDORF, MD 20603-4527
(301) 373-7900
(301) 373-6900

Taxonomy

Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
305905
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
840027000
MD
Enumeration date
12/11/2011
Last updated
12/09/2021
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