Provider Demographics
NPI:1447260054
Name:BENNETT, CATHERINE A (DNP, APRN-BC)
Entity type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:A
Last Name:BENNETT
Suffix:
Gender:F
Credentials:DNP, APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 COMFORT PL
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-5234
Mailing Address - Country:US
Mailing Address - Phone:574-243-3100
Mailing Address - Fax:574-243-3134
Practice Address - Street 1:111 SUNNYBROOK CT
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46637-3437
Practice Address - Country:US
Practice Address - Phone:574-243-3100
Practice Address - Fax:574-243-3134
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704299476363LF0000X
IN28138675A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
0357550-22OtherANCC
ME43990500Medicaid