Individual
JEREMY R. BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RD
Contact information
Practice address
1320 WISCONSIN AVE, RACINE, WI 53403-1978
(262) 687-2781
Mailing address
1320 WISCONSIN AVE, RACINE, WI 53403-1978
(262) 687-2781
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1989-029
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
961328
RD NUMBER
—
Enumeration date
02/08/2008
Last updated
02/08/2008
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