Provider Demographics
NPI:1871307397
Name:BENNETT, ANDRETTA INGE
Entity type:Individual
Prefix:
First Name:ANDRETTA
Middle Name:INGE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8315 WILLOW TRACE CT E
Mailing Address - Street 2:
Mailing Address - City:WILMER
Mailing Address - State:AL
Mailing Address - Zip Code:36587-9528
Mailing Address - Country:US
Mailing Address - Phone:251-605-2180
Mailing Address - Fax:
Practice Address - Street 1:8315 WILLOW TRACE CT E
Practice Address - Street 2:
Practice Address - City:WILMER
Practice Address - State:AL
Practice Address - Zip Code:36587-9528
Practice Address - Country:US
Practice Address - Phone:251-605-2180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL372600000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No372600000XNursing Service Related ProvidersAdult Companion