Individual
KERI LYN BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
515 N 16TH ST, PAYETTE, ID 83661-2774
(208) 642-6416
Mailing address
3402 FRANKLIN RD, CALDWELL, ID 83605-6932
(208) 642-6416
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
201392585RN
OR
163W00000X
Registered Nurse
Primary
46146
ID
Other
Enumeration date
08/16/2016
Last updated
08/16/2016
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