Individual
ETHAN K BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11050 PARKVIEW CIRCLE DR, FORT WAYNE, IN 46845-1739
(833) 724-8326
(260) 266-7935
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28216817A
IN
363L00000X
Nurse Practitioner
Primary
71008988A
IN
Other
Enumeration date
03/29/2019
Last updated
03/07/2023
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