Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 19932 | CA |
NPI | 1033547666 |
---|---|
Provider Name | Ms. Laverne Zeta Bennett |
First Address | Riverside, CA 92507-3970 |
Second Address | Riverside, CA 92507-3970 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2013 |
Last Update Date | 16/10/2013 |