Individual provider · NPI-1

Jacquelyn Alice Bennett, RN

Registered Nurse, Gerontology · Portland, OR

NPI number1083964704
StatusActive
Last updated in NPPESSep 11, 2012

Details

NPI
1083964704
Entity type
Individual (NPI-1)
Name
Mrs. Jacquelyn Alice Bennett
Credential
RN
Sex
Female
Sole proprietor
No
Enumeration date
Sep 11, 2012
Last updated
Sep 11, 2012

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
163WG0600X Registered Nurse, Gerontology200340760RNORYes

Practice location

4540 Ne Glisan St
Portland, OR 97213-2333

Phone 503-215-3738

Mailing address

4540 Ne Glisan St
Portland, OR 97213-2333

Phone 503-215-3738

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