Provider Demographics
NPI:1437996097
Name:BENNETT, MIA EUGENIA (CCP)
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:EUGENIA
Last Name:BENNETT
Suffix:
Gender:F
Credentials:CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9220 WORTHINGTON RD APT 342
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-7271
Mailing Address - Country:US
Mailing Address - Phone:614-783-4921
Mailing Address - Fax:
Practice Address - Street 1:ST. RITA'S MEDICAL CENTER
Practice Address - Street 2:730 W MARKET ST
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801
Practice Address - Country:US
Practice Address - Phone:419-227-3361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI049010242T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist