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Contact Information

NICHOLAS J BENNETT, PA-C
7950 W JEFFERSON BLVD
FORT WAYNE, IN46804-4140
 Phone: 260-203-9600
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physician Assistant

363A00000X 97 Physician Assistant
 

Medical

363AM0700X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for NICHOLAS J BENNETT · (Male)

NPI # 1336649383
Status Active
Credentials PA-C (Physician Assistant-Certified)
Entity Individual
Enumeration date 02/16/2018
Last updated 02/16/2018 - About 8 years ago
Sole proprietor 1 No
Identifiers
  • IN License # 10002413A
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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