Provider Demographics
NPI:1790200012
Name:BENTLEY, CARRIE SAGE (RN)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:SAGE
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 RENDEZVOUS RD
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-9103
Mailing Address - Country:US
Mailing Address - Phone:307-217-1264
Mailing Address - Fax:
Practice Address - Street 1:625 E MADISON AVE STE 1
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-4712
Practice Address - Country:US
Practice Address - Phone:307-463-0337
Practice Address - Fax:307-463-0041
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY32157163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management