Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 72000043A | IN |
N | 363LW0102X | Nurse Practitioner - Women's Health | 72000043A | IN |
N | 363LX0001X | Nurse Practitioner - Obstetrics & Gynecology | 72000043A | IN |
NPI | 1003917774 |
---|---|
Provider Name | Mrs. Christina Lynn Bennett |
First Address | Anderson, IN 46016-4206 |
Second Address | Anderson, IN 46016-4206 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 03/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200272370 | (05) | IN |
200531440 | (05) | IN |