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Individual

GERRY JO BENNETT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
R.N.

Contact information

Practice address
DEPARTMENT OF VETERANS AFFAIRS, 500 FOOTHILL BLVD, SALT LAKE CITY, UT 84148-0001
(801) 582-1565
(801) 584-2557
Mailing address
2486 BROOKGLEN DR, SANDY, UT 84092-7148
(801) 582-1565
(801) 584-2557

Taxonomy

Speciality
Code
Description
License number
State
163WP2201X
Ambulatory Care Registered Nurse
Primary
212587-3102
UT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
212587-3102
DOPL ACTIVE LICENSE
UT
Enumeration date
05/23/2012
Last updated
05/23/2012
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