Provider Demographics
NPI:1326721739
Name:BENNETT, STORMEE KAE
Entity Type:Individual
Prefix:
First Name:STORMEE
Middle Name:KAE
Last Name:BENNETT
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:PO BOX 208
Mailing Address - Street 2:
Mailing Address - City:CASTLE DALE
Mailing Address - State:UT
Mailing Address - Zip Code:84513-0208
Mailing Address - Country:US
Mailing Address - Phone:435-381-2667
Mailing Address - Fax:435-381-2104
Practice Address - Street 1:SEEIP
Practice Address - Street 2:15 E 600 N
Practice Address - City:CASTLE DALE
Practice Address - State:UT
Practice Address - Zip Code:84513
Practice Address - Country:US
Practice Address - Phone:435-381-2667
Practice Address - Fax:435-381-2104
Is Sole Proprietor?:No
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT631372-3012163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse