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Individual

MICHELE L BENNETT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
248 W WORKS ST, SHERIDAN, WY 82801-4213
(307) 673-6100
(307) 673-1975
Mailing address
248 W WORKS ST, SHERIDAN, WY 82801-4213
(307) 673-6100
(307) 673-1975

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
6086A
WY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
113791300
WY
01
313726
BLUE CROSS/BLUE SHIELD
WY
Enumeration date
09/22/2006
Last updated
11/29/2012
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