Provider Demographics
NPI:1881497527
Name:BENNETT, QUANESHA VINES
Entity type:Individual
Prefix:
First Name:QUANESHA
Middle Name:VINES
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 1:829 ROBERSON COMER RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-9281
Mailing Address - Country:US
Mailing Address - Phone:336-686-6279
Mailing Address - Fax:336-686-6279
Practice Address - Street 1:4571 REEDY FORK PKWY
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-8275
Practice Address - Country:US
Practice Address - Phone:336-656-3723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-28
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program