Provider Demographics
NPI:1811662257
Name:BENTLEY, VANESSA RAE (RT(R))
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:RAE
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:RT(R)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-3915
Mailing Address - Country:US
Mailing Address - Phone:423-895-9092
Mailing Address - Fax:
Practice Address - Street 1:419 DIVISION ST
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-3915
Practice Address - Country:US
Practice Address - Phone:423-895-9092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist