Provider Demographics
NPI:1750909099
Name:BENTLEY, RUTH ANN (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:ANN
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MISS
Other - First Name:RUTH
Other - Middle Name:ANN
Other - Last Name:BONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:805 S BROADWAY ST STE 103
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305-5972
Mailing Address - Country:US
Mailing Address - Phone:303-499-0176
Mailing Address - Fax:303-440-3299
Practice Address - Street 1:805 S BROADWAY ST STE 103
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-5972
Practice Address - Country:US
Practice Address - Phone:303-499-0176
Practice Address - Fax:303-440-3299
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0995624-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000187073Medicaid