HEATHER BENNETT CRNFA, NPI 1689649477 — PHOENIX (AZ)

NPI 1689649477

14+ Years Experience Individual

HEATHER BENNETT CRNFA

02/23/2006
PROVIDER ENUMERATION DATE
02.11.2010
LAST UPDATE DATE
1689649477
NPI NUMBER

About HEATHER BENNETT

Sole proprietor? No, Entity Type 1 Provider (Individual) is not a Sole Proprietor.

HEATHER BENNETT is a provider established in PHOENIX, AZ. The NPI number of HEATHER BENNETT is 1689649477 and was assigned on 02/23/2006. The practitioners primary taxonomy code is: 363AS0400X with license number: RN049561 AZ .

Mailing address

  • City: PHOENIX
  • State: AZ
  • Postal code: 850674864
  • Phone: 6022628900
  • Fax: 6024454079
  • Address: PO BOX 34864

Primary Practice Address

  • Region : PHOENIX, AZ
  • NPI : 1689649477
  • Phone : 6022628900
  • Fax : 6024454079
  • Postalcode : 850044527
  • Address : 1850 N CENTRAL AVE SUITE 1600

Additional identifiers

  • Identifier: AZ0169290
  • Code / Type : 1 - other
  • Identifier state : AZ
  • Identifier issuer: BXBS

Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Additional identifiers # 2

  • Identifier: 187501
  • Code / Type : 5 - MEDICAID
  • Identifier state : AZ

Provider taxonomy - Physician Assistant

  • Taxonomy code: 363AS0400X
  • License number: RN049561
  • License state: AZ

The taxonomy is the primary taxonomy (there can be only one per NPI record).

Contacts:

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  • HEATHER BENNETT CRNFA
  • Address : 1850 N CENTRAL AVE SUITE 1600
  • Region : PHOENIX, AZ
  • NPI : 1689649477
  • Phone : 6022628900
  • Fax : 6024454079
  • Postalcode : 850044527

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location Address1850 N CENTRAL AVE
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Second Line Business Practice Location AddressSUITE 1600
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NamePHOENIX
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameAZ
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code850044527
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number6022628900
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number6024454079
The fax number associated with the location address of the provider being identified.
NPI1689649477
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 1363AS0400X
Provider Enumeration Date02/23/2006
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated02.11.2010
The date that a record was last updated or changed.
Entity TypeIndividual
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Organization Name (Legal Business Name)HEATHER BENNETT
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Line Business Mailing AddressPO BOX 34864
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Business Mailing Address City NamePHOENIX
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameAZ
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code850674864
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Telephone Number6022628900
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider Business Mailing Address Fax Number6024454079
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
Healthcare Provider Taxonomy Code #1363AS0400X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Physician Assistant
Provider License Number 1RN049561
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 1AZ
Healthcare Provider Primary Taxonomy Switch 1Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Other Provider Identifier 1AZ0169290
Other Provider Identifier #1
Other Provider Identifier Type 11
  • 1 - Other
  • 5 - MEDICAID
Other Provider Identifier State 1AZ
Other Provider Identifier State #1
Other Provider Identifier Issuer 1BXBS
Other Provider Identifier Issuer #1
Other Provider Identifier 2187501
Other Provider Identifier #2
Other Provider Identifier Type 25
  • 1 - Other
  • 5 - MEDICAID
Other Provider Identifier State 2AZ
Other Provider Identifier State #2
Provider Gender CodeF
  • M - male
  • F - female
Is sole proprietorN
  • X - Not Answered
  • Y - Yes, Entity Type 1 Provider (Individual) is a Sole Proprietor
  • N - No, Entity Type 1 Provider (Individual) is not a Sole Proprietor
X

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