Individual
KENDEL NICOLE BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2095 EXCHANGE ST STE 301, ASTORIA, OR 97103-3400
(503) 338-4087
Mailing address
3155 SW MOODY AVE APT 219, PORTLAND, OR 97239-4703
(303) 947-1277
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
190537
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/14/2016
Last updated
01/03/2019
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