Individual
TAMIE BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ADULT GERONTOLOGY NP
Contact information
Practice address
227 E WAUPUN ST, OAKFIELD, WI 53065-9746
(920) 583-2631
Mailing address
227 E WAUPUN ST, OAKFIELD, WI 53065-9746
(920) 583-2631
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
5949-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
WISCONSIN
—
WI
Enumeration date
12/01/2014
Last updated
12/01/2014
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