Healthcare Provider Details

I. General information

NPI: 1679790802
Provider Name (Legal Business Name): MICHELE HELEN BENNETT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 E 10TH ST
TUCSON AZ
85719-5813
US

IV. Provider business mailing address

1010 E 10TH ST
TUCSON AZ
85719-5813
US

V. Phone/Fax

Practice location:
  • Phone: 520-908-4317
  • Fax: 520-908-4301
Mailing address:
  • Phone: 520-908-4317
  • Fax: 520-908-4301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN096718
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: