Individual
JENNIFER LYNN BENNETTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
781 36TH ST SE, WYOMING, MI 49548-2319
(616) 252-4100
Mailing address
5900 BYRON CENTER AVE SW, MEDICAL ADMINISTRATION, WYOMING, MI 49519-9606
(616) 252-4100
(616) 252-4953
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704216401
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1366814006
—
MI
Enumeration date
10/21/2015
Last updated
10/03/2018
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