Provider Demographics
NPI:1538596945
Name:BENNETT, TRISHA C (RN, BSN)
Entity type:Individual
Prefix:MRS
First Name:TRISHA
Middle Name:C
Last Name:BENNETT
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2064 PRAIRIE MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:KRONENWETTER
Mailing Address - State:WI
Mailing Address - Zip Code:54455-8193
Mailing Address - Country:US
Mailing Address - Phone:715-676-0300
Mailing Address - Fax:
Practice Address - Street 1:2064 PRAIRIE MEADOW DR
Practice Address - Street 2:
Practice Address - City:KRONENWETTER
Practice Address - State:WI
Practice Address - Zip Code:54455-8193
Practice Address - Country:US
Practice Address - Phone:715-676-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI154549-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse