Healthcare Provider Details

I. General information

NPI: 1033372974
Provider Name (Legal Business Name): KIM BENNETT CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 08/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PEACH ST SUITE 300
ERIE PA
16507-1423
US

IV. Provider business mailing address

100 PEACH ST SUITE 300
ERIE PA
16507-1423
US

V. Phone/Fax

Practice location:
  • Phone: 814-459-1851
  • Fax: 814-456-0541
Mailing address:
  • Phone: 814-459-1851
  • Fax: 814-456-0541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW008374L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: