Individual
RENEALLIA BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3075 N WINDSONG DR STE A, PRESCOTT VALLEY, AZ 86314-1208
(928) 350-8780
(888) 674-1228
Mailing address
P.O. BOX 600, TUBA CITY, AZ 86045-0600
(928) 283-2501
(928) 283-2677
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
252630
AZ
Other
Enumeration date
11/01/2012
Last updated
06/22/2021
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