Provider Demographics
NPI:1235406836
Name:BENTLEY, AUTUMN (PCA, STNA)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:PCA, STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6088 THOMPSON RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-2631
Mailing Address - Country:US
Mailing Address - Phone:513-515-9935
Mailing Address - Fax:
Practice Address - Street 1:6088 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45247-2631
Practice Address - Country:US
Practice Address - Phone:513-515-9935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-27
Last Update Date:2011-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400934340609376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide