Provider Demographics
NPI:1841634540
Name:BENTLEY, LISA RENEE (RN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:RENEE
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 DANIEL CT
Mailing Address - Street 2:13G
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45244-1400
Mailing Address - Country:US
Mailing Address - Phone:513-549-3533
Mailing Address - Fax:513-843-6158
Practice Address - Street 1:640 DANIEL CT
Practice Address - Street 2:13G
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45244-1400
Practice Address - Country:US
Practice Address - Phone:513-549-3533
Practice Address - Fax:513-843-6158
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN215746163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRN-215746OtherRN LICENSE