Individual
MIKAELA EILEEN BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4837 SILO HILLS DR, SPRINGFIELD, MO 65802-7120
(913) 653-4047
Mailing address
4837 SILO HILLS DR, SPRINGFIELD, MO 65802-7120
(913) 653-4047
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
05/16/2023
Last updated
05/16/2023
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