Healthcare Provider Details

I. General information

NPI: 1730095522
Provider Name (Legal Business Name): RAYCHEL L BENTLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4213 O ST
LINCOLN NE
68510-1751
US

IV. Provider business mailing address

2920 N 51ST ST
LINCOLN NE
68504-2709
US

V. Phone/Fax

Practice location:
  • Phone: 402-419-4850
  • Fax: 531-500-2407
Mailing address:
  • Phone:
  • Fax: 531-500-4729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: