Healthcare Provider Details

I. General information

NPI: 1447636238
Provider Name (Legal Business Name): SHARON BENNER C.P.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2015
Last Update Date: 08/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 4TH ST
BALDWIN MI
49304-9518
US

IV. Provider business mailing address

1615 MICHIGAN AVE
BALDWIN MI
49304-7984
US

V. Phone/Fax

Practice location:
  • Phone: 231-745-3116
  • Fax: 231-745-3136
Mailing address:
  • Phone: 231-745-4624
  • Fax: 231-745-5031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number4704170006
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: