Provider Demographics
NPI:1356773329
Name:BENNETT, JILLIAN ELIZABETH (CPM)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:ELIZABETH
Last Name:BENNETT
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9426 N WISE RD
Mailing Address - Street 2:CLARE
Mailing Address - City:CLARE
Mailing Address - State:MI
Mailing Address - Zip Code:48617-9123
Mailing Address - Country:US
Mailing Address - Phone:989-802-2022
Mailing Address - Fax:855-802-2971
Practice Address - Street 1:304 W MICHIGAN ST
Practice Address - Street 2:SUITE 6
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2492
Practice Address - Country:US
Practice Address - Phone:989-802-2022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-01
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife