Provider Demographics
NPI:1215761523
Name:BENNETT, TAMEKKA LATRYCE (LPN, CFLE)
Entity type:Individual
Prefix:MS
First Name:TAMEKKA
Middle Name:LATRYCE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LPN, CFLE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3180 WELLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-2141
Mailing Address - Country:US
Mailing Address - Phone:269-348-3641
Mailing Address - Fax:
Practice Address - Street 1:3180 WELLINGTON RD
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-2141
Practice Address - Country:US
Practice Address - Phone:269-348-3641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty