Provider Demographics
NPI:1144999210
Name:BENNETT, ROSEMARY HEATHER (RN)
Entity type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:HEATHER
Last Name:BENNETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ROSEMARY
Other - Middle Name:HEATHER
Other - Last Name:POHLENZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:530 NW 27TH ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-5223
Mailing Address - Country:US
Mailing Address - Phone:541-766-6835
Mailing Address - Fax:
Practice Address - Street 1:414 N 2ND ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:OR
Practice Address - Zip Code:97352-9706
Practice Address - Country:US
Practice Address - Phone:503-374-4343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200842417RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR200842417RNOtherOSBN