Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0000X | Nurse Practitioner - Neonatal | 105452 | TX |
Y | 363LN0000X | Nurse Practitioner - Neonatal | AP105453 | TX |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 539694 | TX |
NPI | 1174899140 |
---|---|
Provider Name | Penny Bennett |
First Address | San Antonio, TX 78229-3539 |
Second Address | San Antonio, TX 78229-3539 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2012 |
Last Update Date | 09/12/2020 |