Provider Demographics
NPI:1891508453
Name:BENNETT, SHONNETTE (NP)
Entity type:Individual
Prefix:
First Name:SHONNETTE
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5786 ASPEN VIEW PL
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-4642
Mailing Address - Country:US
Mailing Address - Phone:386-690-7984
Mailing Address - Fax:
Practice Address - Street 1:5786 ASPEN VIEW PL
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-4642
Practice Address - Country:US
Practice Address - Phone:386-690-7984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.1000497-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health