Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | F338826 | NY |
N | 363LP2300X | Nurse Practitioner - Primary Care | F338826 | NY |
NPI | 1063812741 |
---|---|
Provider Name | Ms. Susanne Lester-Bennett |
First Address | Camp Lejeune, NC 28547-2575 |
Second Address | Roswell, GA 30076-2259 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2014 |
Last Update Date | 30/12/2021 |