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General NPI Number Information
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NPI Number | 1396076477
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Entity Type | Individual
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Provider Name | SHANNON LOUISE BENNETT LM,CPM
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Gender | Female
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Dates
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Enumeration Date | 01/29/2010
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Last Update Date | 12/07/2015
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Provider Practice Location Address
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Address Line | 2207 ROCHELLE LN
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City | WEST RICHLAND
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State | WA
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Zip | 99353-9505
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Country | US
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Telephone | 509-308-3711
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Fax | 509-967-4625
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Provider Business Mailing Address
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Address Line | 2207 ROCHELLE LN
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City | WEST RICHLAND
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State | WA
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Zip | 99353-9505
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Country | US
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Telephone | 509-308-3711
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Fax | 509-967-4625
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | MW
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License Number State | WA
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