Individual
KAITLIN ELYSE BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1 UNIVERSITY BLVD, ALBUQUERQUE, NM 87131-0001
(505) 277-0111
Mailing address
1962 CAMINO DURASNILLA, LOS ALAMOS, NM 87544
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
02/11/2019
Last updated
02/11/2019
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