Provider Demographics
NPI:1467485342
Name:BENTLEY, JOAN N (FNP)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:N
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3570 W 9000 S STE 200
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-8875
Mailing Address - Country:US
Mailing Address - Phone:801-566-9211
Mailing Address - Fax:801-566-5667
Practice Address - Street 1:3570 W 9000 S STE 200
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-8875
Practice Address - Country:US
Practice Address - Phone:801-566-9211
Practice Address - Fax:801-566-5667
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT176931-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT07159Medicaid
UTP72324Medicare UPIN