Provider Demographics
NPI:1306312459
Name:BENNETT, DEBORAH LEE
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LEE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 TIMBER CT APT 112
Mailing Address - Street 2:
Mailing Address - City:TERRELL
Mailing Address - State:TX
Mailing Address - Zip Code:75160-2331
Mailing Address - Country:US
Mailing Address - Phone:608-566-4707
Mailing Address - Fax:
Practice Address - Street 1:201 TIMBER CT APT 112
Practice Address - Street 2:
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-2331
Practice Address - Country:US
Practice Address - Phone:608-566-4707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX546595163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse