| NPI | 1184801375 |
|---|---|
| Former Name | ANDREA BENNETT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2011003921) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2008-01-30 |
| Last Update Date | 2018-05-11 |