Doctor Name: | AMANDA DAWN BENNETT |
NPI Number: | 1558329862 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP-C |
License Number: | RN109910/AP1963 |
Business Practice Address: | 801 W Rex Allen Dr Willcox, AZ - 856431129 |
Business Phone Number: | 5207665000 |
Business Fax Number: | 5207665001 |
Mailing Address: | 801 W Rex Allen Dr, WILLCOX |
State: | AZ |
Postal Code: | 85643 |
Phone Number: | 5207665000 |
Fax Number: | 5203845001 |
NPI Enumeration Date: | 05/03/2006 |
NPI Last Update Date: | 10/17/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | RN109910/AP1963 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |