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General NPI Number Information
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NPI Number | 1689158651
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Entity Type | Individual
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Provider Name | DAYNA NATALIA BENNETT FNP-C
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Gender | Female
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Dates
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Enumeration Date | 09/17/2018
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Last Update Date | 06/28/2023
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Provider Practice Location Address
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Address Line | 2111 PONTIAC LAKE RD
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City | WATERFORD
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State | MI
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Zip | 48328-2736
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Country | US
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Telephone | 947-500-1691
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Fax |
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Provider Business Mailing Address
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Address Line | 1250 KINLOCK DR
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City | TROY
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State | MI
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Zip | 48098-2027
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Country | US
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Telephone | 248-660-7882
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704266910
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License Number State | MI
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