Individual
TASHINA BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4066 DUNNICA AVE, SAINT LOUIS, MO 63116-3510
(636) 224-1700
Mailing address
118 N 2ND ST STE 200, SAINT CHARLES, MO 63301-2894
(636) 224-1224
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
B53080186695
IL
Other
Enumeration date
10/28/2019
Last updated
09/18/2024
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