Individual
MARK RICHARD BENNETT JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
709 W MAIN ST, MANCHESTER, IA 52057-1526
(563) 822-1435
(563) 822-1436
Mailing address
709 W MAIN ST, MANCHESTER, IA 52057-1526
(563) 822-1435
(563) 822-1436
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
D131948
IA
Other
Enumeration date
03/23/2016
Last updated
02/19/2019
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