Individual
MR. EDWARD W. BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
15855 19 MILE RD, CLINTON TWP, MI 48038-3504
(586) 263-2370
Mailing address
77148 N MARY GRACE CT, ROMEO, MI 48065-2638
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704161446
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4287914
—
MI
01
—
EB161446
BLUE CROSS
MI
Enumeration date
09/25/2006
Last updated
07/08/2007
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