Provider Demographics
NPI:1497846240
Name:BENTZ, ANDREA RENEE (RT R)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:RENEE
Last Name:BENTZ
Suffix:
Gender:F
Credentials:RT R
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Mailing Address - Street 1:1309 POWERS AVENUE
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501
Mailing Address - Country:US
Mailing Address - Phone:208-743-0336
Mailing Address - Fax:208-743-0336
Practice Address - Street 1:111 BEVER GRADE
Practice Address - Street 2:NIMIIPUU HEALTH
Practice Address - City:LAPWAI
Practice Address - State:ID
Practice Address - Zip Code:83540
Practice Address - Country:US
Practice Address - Phone:208-843-2271
Practice Address - Fax:208-843-9163
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
ID407815247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist