Provider Demographics
NPI:1831907450
Name:BENNETT, PATRICK STEPHEN (AGACNP-BC)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:STEPHEN
Last Name:BENNETT
Suffix:
Gender:M
Credentials:AGACNP-BC
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:182 GREGG DR
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49014-7829
Mailing Address - Country:US
Mailing Address - Phone:269-589-2374
Mailing Address - Fax:
Practice Address - Street 1:5280 METRO PKWY
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-4005
Practice Address - Country:US
Practice Address - Phone:586-722-7519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-28
Last Update Date:2024-12-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704360346163W00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse