Most Relevant Information
Provider Data
| NPI Number: | 1003428640 |
| Provider Name: | TYLER BENNINK |
| Entity Type: | Individual |
| Taxonomy Code: | 172V00000X |
| Specialty: | Community Health Worker |
| License Number: |
Most Important Dates
| Enumeration Date: | 08/17/2020 |
| Last Updated: | 08/17/2020 |
Provider Practice Location
13947 S NEWBURG DR
HERRIMAN
UT
840966787
Practice Location Phone/Fax
| Phone: | 8015066695 |
| Fax: |
Provider Mailing Location
13947 S NEWBURG DR
HERRIMAN
UT
840966787
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |