Individual
MARY ELLEN BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.P.N.
Contact information
Practice address
1200 GRIFFITH WAY, LOT # 6, DOUGLAS, WY 82633-2372
(307) 389-0984
Mailing address
1200 GRIFFITH WAY, LOT # 6, DOUGLAS, WY 82633-2372
(307) 389-0984
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
6611
WY
Other
Enumeration date
03/17/2008
Last updated
03/17/2008
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