Basic Information
| Provider Information | |||||||||
| NPI: | 1770886764 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BENNICK | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 YORK ST | ||||||||
| Address2: | LCI 708, DEPT OF NEUROLOGY | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065103220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037856351 | ||||||||
| FaxNumber: | 2037862238 | ||||||||
| Practice Location | |||||||||
| Address1: | 40 TEMPLE ST | ||||||||
| Address2: | SUITE 6C | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065102715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037854085 | ||||||||
| FaxNumber: | 2037854937 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2010 | ||||||||
| LastUpdateDate: | 06/24/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 004413 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.