Individual
KELLY BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
549 NICHOLAS RD, IONIA, MI 48846-9419
(616) 835-2965
Mailing address
549 NICHOLAS RD, IONIA, MI 48846-9419
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703112356
MI
Other
Enumeration date
07/31/2023
Last updated
07/31/2023
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