Provider Demographics
NPI:1184020240
Name:BENTZ, LINDA (CPM, LM)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:BENTZ
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 PARKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WI
Mailing Address - Zip Code:53563-1714
Mailing Address - Country:US
Mailing Address - Phone:608-718-9510
Mailing Address - Fax:
Practice Address - Street 1:709 PARKVIEW DR
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:WI
Practice Address - Zip Code:53563-1714
Practice Address - Country:US
Practice Address - Phone:608-718-9510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI58-049176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife