Provider Demographics
NPI:1932511730
Name:BENTLEY, MAUREEN (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 COCHRANE CIR
Mailing Address - Street 2:EBHT 3 BLDG 1150
Mailing Address - City:FT. CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913
Mailing Address - Country:US
Mailing Address - Phone:719-526-4137
Mailing Address - Fax:
Practice Address - Street 1:1364 BARKELEY AVE BLDG 1150
Practice Address - Street 2:
Practice Address - City:FT. CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913
Practice Address - Country:US
Practice Address - Phone:719-526-4137
Practice Address - Fax:719-526-2452
Is Sole Proprietor?:No
Enumeration Date:2014-05-28
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-03222363LP0808X
COCAPN.0002363-C-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM58709801Medicaid
IN344840039Medicare PIN
IN201256220Medicaid