| Doctor Name: | JESSICA BENNETT |
| NPI Number: | 1295127538 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 4704283124 |
| Business Practice Address: | 1360 N Saint Helen Rd Saint Helen, MI - 486569521 |
| Business Phone Number: | 9894142814 |
| Business Fax Number: | |
| Mailing Address: | 4967 Crooks Rd, TROY |
| State: | MI |
| Postal Code: | 480985801 |
| Phone Number: | 2489521601 |
| Fax Number: | 2489521614 |
| NPI Enumeration Date: | 02/24/2015 |
| NPI Last Update Date: | 07/24/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 4704283124 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |