Provider Demographics
NPI:1508816067
Name:BENTLEY, NORA L (CRNA)
Entity Type:Individual
Prefix:
First Name:NORA
Middle Name:L
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 E WATERLOO RD STE 313
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-3856
Mailing Address - Country:US
Mailing Address - Phone:330-208-2720
Mailing Address - Fax:330-208-2721
Practice Address - Street 1:3780 MEDINA RD STE 120
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-9312
Practice Address - Country:US
Practice Address - Phone:330-208-2720
Practice Address - Fax:330-208-2721
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-196070367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH34-0891295OtherEMPLOYER FEDERAL TAX ID #
OH730617OtherBUCKEYE COMMUNITY HLTH PL
OH120805OtherKAISER PERMANENTE INDV #
OH000000125743OtherANTHEM BCBS INDV NUMBER
OH7091249Medicaid
OH100153OtherEMPLOYER KAISER GROUP #
OH0863623Medicaid
OH2080224OtherEMP UNITED HEALTHCARE GRP
OHWH8209631Medicare ID - Type UnspecifiedMEDICARE INDV NUMBER
OH8000281Medicare ID - Type UnspecifiedEMPLYR MEDICARE CRNA GRP#
OH100153OtherEMPLOYER KAISER GROUP #
OHCN1092Medicare ID - Type UnspecifiedEMPLOYER RR MEDICARE GRP#