Provider Demographics
NPI:1528799343
Name:BENNOV, RACHEL ROSE (CRNP)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:ROSE
Last Name:BENNOV
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 S 47TH ST APT 204
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-4426
Mailing Address - Country:US
Mailing Address - Phone:215-416-4414
Mailing Address - Fax:
Practice Address - Street 1:220 S 47TH ST APT 204
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-4426
Practice Address - Country:US
Practice Address - Phone:215-416-4414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP025607363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology