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Individual
SHANON DIONE BENNETT
Active
Individual
SHANON DIONE BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
001016
IA
363AM0700X
Medical Physician Assistant
001000136
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
970024832
RR MEDICARE
IA
Enumeration date
04/05/2006
Last updated
07/21/2022
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