Provider Demographics
NPI:1720352206
Name:BENNETT, JUDITH A (RN)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:A
Last Name:BENNETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5213 MANITOWOC PKWY
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-4708
Mailing Address - Country:US
Mailing Address - Phone:608-467-2802
Mailing Address - Fax:608-468-2802
Practice Address - Street 1:5213 MANITOWOC PKWY
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-4708
Practice Address - Country:US
Practice Address - Phone:608-467-2802
Practice Address - Fax:608-468-2802
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI164540163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse