Individual
SAMANTHA NICOLE BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1896 W 9525 S, SOUTH JORDAN, UT 84095-2397
(801) 680-3184
Mailing address
1896 W 9525 S, SOUTH JORDAN, UT 84095-2397
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
1061211
TX
Other
Enumeration date
09/04/2023
Last updated
09/04/2023
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