Provider Demographics
NPI:1255334884
Name:BENTLEY, DEENA MARIE (PAC)
Entity type:Individual
Prefix:MS
First Name:DEENA
Middle Name:MARIE
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:DEENA
Other - Middle Name:MARIE
Other - Last Name:BECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3366
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47732-3366
Mailing Address - Country:US
Mailing Address - Phone:812-477-1560
Mailing Address - Fax:812-477-1595
Practice Address - Street 1:4233 GATEWAY BLVD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-8900
Practice Address - Country:US
Practice Address - Phone:812-477-1560
Practice Address - Fax:812-477-1595
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA493363A00000X
IN363AS0400X
IN10000279A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
INS82835Medicare UPIN
IN257900033Medicare PIN
IN534980008Medicare PIN
INS82835Medicare UPIN