Provider Demographics
NPI:1235960451
Name:BENNETT, DONALD GLENN
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:GLENN
Last Name:BENNETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:457 ROCKGLEN DR
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-8117
Mailing Address - Country:US
Mailing Address - Phone:330-606-9106
Mailing Address - Fax:
Practice Address - Street 1:457 ROCKGLEN DR
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-8117
Practice Address - Country:US
Practice Address - Phone:330-606-9106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care