Individual
NICHOLAS J BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
7950 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4140
(260) 203-9600
Mailing address
10343 DAWSONS CREEK BLVD STE A, FORT WAYNE, IN 46825-1906
(260) 203-9600
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10002413A
IN
363AM0700X
Medical Physician Assistant
10002413A
IN
Other
Enumeration date
02/16/2018
Last updated
02/16/2018
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