Provider Demographics
NPI:1902196009
Name:BENTLEY, MARYANN D (RN, BSN, MSN)
Entity Type:Individual
Prefix:MRS
First Name:MARYANN
Middle Name:D
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:RN, BSN, MSN
Other - Prefix:MISS
Other - First Name:MARYANN
Other - Middle Name:D
Other - Last Name:DECOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7072 MAPLE ST.
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060
Mailing Address - Country:US
Mailing Address - Phone:440-479-2977
Mailing Address - Fax:
Practice Address - Street 1:7072 MAPLE ST
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4937
Practice Address - Country:US
Practice Address - Phone:440-479-2977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-11
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH314670163W00000X
OH024620363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse