Provider Demographics
NPI:1780191460
Name:BENTKOWSKI, ORNELLA ELIZABETH
Entity Type:Individual
Prefix:
First Name:ORNELLA
Middle Name:ELIZABETH
Last Name:BENTKOWSKI
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 1:9917 CEDARDALE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-6113
Mailing Address - Country:US
Mailing Address - Phone:281-961-9823
Mailing Address - Fax:
Practice Address - Street 1:11302 FALLBROOK DR STE 202A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-5272
Practice Address - Country:US
Practice Address - Phone:281-890-4285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-04
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA11579363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical