Basic Information
| Provider Information | |||||||||
| NPI: | 1457004335 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BENNETT | ||||||||
| FirstName: | EFFAT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6400 FANNIN ST STE 2900 | ||||||||
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| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770301555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134861170 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11914 ASTORIA BLVD STE 510 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770896050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2167023076 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2022 | ||||||||
| LastUpdateDate: | 10/28/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | 1059403 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.