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NPI Code Detail

MEDICARE: SHARON BENNER C.P.N.P.

MEDICARE: SHARON BENNER C.P.N.P.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WP0200XPediatric Registered Nurse4704170006MI

General Provider Information

NPI Number : 1447636238
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHARON BENNER C.P.N.P.
Provider Business Mailing Address
First Line : 1615 MICHIGAN AVE
Second Line :
City : BALDWIN
State : MI
Zip : 49304-7984
Country : US
Telephone Number : 231-745-4624
Fax Number : 231-745-5031
Provider Business Practice Location Address
First Line : 525 4TH ST
Second Line :
City : BALDWIN
State : MI
Zip : 49304-9518
Country : US
Telephone Number : 231-745-3116
Fax Number : 231-745-3136
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2015
Last Update Date : 08/04/2015

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