Provider Demographics
NPI:1750446522
Name:BENNETT, HELLEN (CNM)
Entity Type:Individual
Prefix:
First Name:HELLEN
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:HELLEN
Other - Middle Name:
Other - Last Name:HARLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:PO BOX 2137
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48012-2137
Mailing Address - Country:US
Mailing Address - Phone:248-872-1200
Mailing Address - Fax:
Practice Address - Street 1:1428 S LAPEER RD
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48360-1437
Practice Address - Country:US
Practice Address - Phone:248-872-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704101023367A00000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0877522OtherBCBSM IND PIN
MIP31360020Medicare PIN
MI700F110160OtherBLUE CROSS GROUP