Provider Demographics
NPI:1699930560
Name:BENNETT, DONNA RAE (CRNP)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:RAE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E DONNER AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MONESSEN
Mailing Address - State:PA
Mailing Address - Zip Code:15062-1388
Mailing Address - Country:US
Mailing Address - Phone:724-684-8999
Mailing Address - Fax:724-684-8983
Practice Address - Street 1:301 E DONNER AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MONESSEN
Practice Address - State:PA
Practice Address - Zip Code:15062-1388
Practice Address - Country:US
Practice Address - Phone:724-684-8999
Practice Address - Fax:724-684-8983
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP005902W363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner