Provider Demographics
NPI:1982618559
Name:WRIGHT-BENNION, JENNIFER C (CNM)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:C
Last Name:WRIGHT-BENNION
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22424 S ELLSWORTH LOOP RD UNIT 1007
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-7124
Mailing Address - Country:US
Mailing Address - Phone:480-550-5117
Mailing Address - Fax:480-452-1716
Practice Address - Street 1:21321 E OCOTILLO RD STE 126
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-5995
Practice Address - Country:US
Practice Address - Phone:480-550-5117
Practice Address - Fax:833-424-7117
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2877344402367A00000X
AZAP5401367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ978215Medicaid