Healthcare Provider Details

I. General information

NPI: 1760095137
Provider Name (Legal Business Name): GINA LOUISE BENNETT NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2020
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 E WASHINGTON ST
IONIA MI
48846-2202
US

IV. Provider business mailing address

4871 HARWOOD RD
IONIA MI
48846-9422
US

V. Phone/Fax

Practice location:
  • Phone: 269-838-2527
  • Fax:
Mailing address:
  • Phone: 269-838-2527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704240307
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: