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Individual
KRISTINE M BENNETT
Active
Individual
KRISTINE M 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
0010-04920
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0451514334
BCBS PROVIDER ID#
IL
01
—
85000828
LICENSE
IL
Enumeration date
07/10/2006
Last updated
12/09/2024
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