Individual
AMANDA DAWN BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
801 W REX ALLEN DR, WILLCOX, AZ 85643-1129
(520) 766-5000
(520) 766-5001
Mailing address
801 W REX ALLEN DR, WILLCOX, AZ 85643
(520) 766-5000
(520) 384-5001
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN109910/AP1963
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
868482
—
AZ
Enumeration date
05/03/2006
Last updated
10/17/2011
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