| NPI | 1114289535 |
|---|---|
| Former Name | JACQUELINE BENNETT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WV 110249) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001196726) |
| 163W00000X Registered Nurse (Licence: WV 72420) | |
| Enumeration Date | 2012-06-12 |
| Last Update Date | 2021-10-01 |