Individual
JERRIE DAWN BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
417 S INDIANA AVE, TRINIDAD, CO 81082-3126
(719) 846-4416
(719) 846-6408
Mailing address
41 MONTEBELLO RD STE 200, PUEBLO, CO 81001-1366
(719) 545-2746
(719) 542-9638
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN.1636886
CO
Other
Enumeration date
10/04/2017
Last updated
03/17/2018
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