Individual
ANGELA BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
4647 LOWELL AVE NE, KEIZER, OR 97303-3842
(503) 508-9609
Mailing address
4647 LOWELL AVE NE, KEIZER, OR 97303-3842
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
201407422LPN
OR
Other
Enumeration date
08/16/2017
Last updated
08/16/2017
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