Provider Demographics
NPI:1699063446
Name:BENNETT, NOELLE C (PA-C)
Entity type:Individual
Prefix:
First Name:NOELLE
Middle Name:C
Last Name:BENNETT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NOELLE
Other - Middle Name:C
Other - Last Name:HENRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 3014
Mailing Address - Street 2:1215 DUFF AVENUE
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-3014
Mailing Address - Country:US
Mailing Address - Phone:515-956-4100
Mailing Address - Fax:515-956-4108
Practice Address - Street 1:1215 DUFF AVE
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-5400
Practice Address - Country:US
Practice Address - Phone:515-239-4480
Practice Address - Fax:515-239-4716
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002209363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant