Provider Demographics
NPI:1205074267
Name:BENTLER, MARY CATHERINE (PA)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CATHERINE
Last Name:BENTLER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1225 S GEAR AVE
Mailing Address - Street 2:SUITE 153
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-1691
Mailing Address - Country:US
Mailing Address - Phone:319-754-4400
Mailing Address - Fax:319-754-4412
Practice Address - Street 1:1225 S GEAR AVE
Practice Address - Street 2:SUITE 153
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1691
Practice Address - Country:US
Practice Address - Phone:319-754-4400
Practice Address - Fax:319-754-4412
Is Sole Proprietor?:No
Enumeration Date:2009-01-29
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA001970363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1205074267OtherWELLMARK BLUE CROSS/BLUE SHIELD
IA1275533713Medicaid
IA1205074267OtherWELLMARK BLUE CROSS/BLUE SHIELD
IAI5481009Medicare PIN