Individual
TYRANCE BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2250 HICKORY RD, PLYMOUTH MEETING, PA 19462-1047
(610) 834-1122
Mailing address
2058 W BROAD ST, BETHLEHEM, PA 18018-3246
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN152568L
PA
Other
Enumeration date
07/21/2008
Last updated
07/21/2008
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