Provider Demographics
NPI:1992876726
Name:BENNETT, PAULA ANN (MD)
Entity type:Individual
Prefix:DR
First Name:PAULA
Middle Name:ANN
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:P.O. BOX HH
Mailing Address - Street 2:HWY 75/77
Mailing Address - City:WINNEBAGO
Mailing Address - State:NE
Mailing Address - Zip Code:68071
Mailing Address - Country:US
Mailing Address - Phone:402-878-2231
Mailing Address - Fax:402-878-2535
Practice Address - Street 1:HIGHWAY 75/77
Practice Address - Street 2:WINNEBAGO PHS HOSPITAL,
Practice Address - City:WINNEBAGO
Practice Address - State:NE
Practice Address - Zip Code:68071-0767
Practice Address - Country:US
Practice Address - Phone:402-878-2231
Practice Address - Fax:402-878-2535
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2007011369207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10068419OtherCDPHP
NY2875073OtherAETNA HMO
NY5286AOtherEMPIRE BC BS
NY603347OtherMVP
NYP2644327OtherOXFORD HEALTH PLANS
MO326043511OtherMISSOURI MEDICARE
NY58211OtherGHI
NY5797739OtherAETNA NON HMO
NY5797739OtherAETNA NON HMO