Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | MW008374L | PA |
NPI | 1033372974 |
---|---|
Provider Name | Kim Bennett |
First Address | Erie, PA 16507-1423 |
Second Address | Erie, PA 16507-1423 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2008 |
Last Update Date | 08/08/2016 |