Provider Demographics
NPI:1295016483
Name:BENNETTS, ALICE ELIZABETH
Entity Type:Individual
Prefix:MS
First Name:ALICE
Middle Name:ELIZABETH
Last Name:BENNETTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 FARM RD
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-8085
Mailing Address - Country:US
Mailing Address - Phone:406-756-8455
Mailing Address - Fax:
Practice Address - Street 1:680 FARM RD
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-8085
Practice Address - Country:US
Practice Address - Phone:406-756-8455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT43175M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay