Individual
JASON MARK BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
301 PROSPECT AVE, SYRACUSE, NY 13203-1899
(315) 448-5111
Mailing address
1286 HARMONY RD, SUSQUEHANNA, PA 18847-7633
(570) 396-1292
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
676671-1
NY
367500000X
Certified Registered Nurse Anesthetist
Primary
128442
NY
Other
Enumeration date
12/18/2019
Last updated
03/06/2020
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