Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 51413-20 | WI |
NPI | 1003852161 |
---|---|
Provider Name | Eliza A. Bennett |
First Address | Madison, WI 53715-1349 |
Second Address | Madison, WI 53715-1348 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2006 |
Last Update Date | 04/01/2021 |