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Individual

LAURREN ASHLEY BENNETT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
740 S WOODRUFF AVE, IDAHO FALLS, ID 83401-5285
(209) 542-9111
Mailing address
720 KIMBERLY DR, IDAHO FALLS, ID 83401-3838
(208) 520-2025

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-2020
ID

Other

Enumeration date
02/17/2021
Last updated
02/17/2021
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