MEDICARE: MRS. SHANNON LOUISE BENNETT LM,CPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	176B00000X	Midwife	MW	WA

General Provider Information

NPI Number	:	1396076477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHANNON LOUISE BENNETT LM,CPM

Provider Business Mailing Address
First Line	:	2207 ROCHELLE LN
Second Line	:
City	:	WEST RICHLAND
State	:	WA
Zip	:	99353-9505
Country	:	US
Telephone Number	:	509-308-3711
Fax Number	:	509-967-4625

Provider Business Practice Location Address
First Line	:	2207 ROCHELLE LN
Second Line	:
City	:	WEST RICHLAND
State	:	WA
Zip	:	99353-9505
Country	:	US
Telephone Number	:	509-308-3711
Fax Number	:	509-967-4625

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2010
Last Update Date	:	12/07/2015

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