| NPI | 1417085697 |
|---|---|
| Former Legal Business Name | IDA WALLACE BENNETT FAMILY CORPORATION |
| Entity Type | Organization |
| Authorized Contact | PAMELA V JOHNSON President 561-900-6737 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP2155102) |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2013-07-16 |