1225295330 NPI number — DR. ELIZABETH MULLEN BENNETT M.D.

Table of content: DR. ELIZABETH MULLEN BENNETT M.D. (NPI 1225295330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225295330 NPI number — DR. ELIZABETH MULLEN BENNETT M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENNETT
Provider First Name:
ELIZABETH
Provider Middle Name:
MULLEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BENNETT-SOFIE
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
MULLEN
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1225295330
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
415 EVERWOOD CT NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ISSAQUAH
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98027-2602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-419-0089
Provider Business Mailing Address Fax Number:
425-313-9533

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
415 EVERWOOD CT NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ISSAQUAH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98027-2602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-419-0089
Provider Business Practice Location Address Fax Number:
425-313-9533
Provider Enumeration Date:
05/19/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MD00033971 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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