Provider Demographics
NPI:1871695007
Name:BENNETT, JANE ELIZABETH (NP)
Entity type:Individual
Prefix:MRS
First Name:JANE
Middle Name:ELIZABETH
Last Name:BENNETT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:JANE
Other - Middle Name:ELIZABETH
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:1651 HEDGE LN
Mailing Address - Street 2:
Mailing Address - City:CAZENOVIA
Mailing Address - State:NY
Mailing Address - Zip Code:13035-9652
Mailing Address - Country:US
Mailing Address - Phone:315-655-3175
Mailing Address - Fax:
Practice Address - Street 1:750 E ADAMS ST
Practice Address - Street 2:JACOBSON HALL 4TH FLOOR
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2306
Practice Address - Country:US
Practice Address - Phone:315-464-4260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF300463363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health