Provider Demographics
NPI:1083240691
Name:BENTLEY, NATHALIE MICHELLE
Entity Type:Individual
Prefix:MRS
First Name:NATHALIE
Middle Name:MICHELLE
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 SABLE DR
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-9022
Mailing Address - Country:US
Mailing Address - Phone:981-223-2622
Mailing Address - Fax:
Practice Address - Street 1:102 SABLE DR
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-9022
Practice Address - Country:US
Practice Address - Phone:981-223-2622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-14
Last Update Date:2020-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12142183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist