Healthcare Provider Details

I. General information

NPI: 1902196009
Provider Name (Legal Business Name): MARYANN D. BENTLEY RN, BSN, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS MARYANN D. DECOLA

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 08/31/2020
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7072 MAPLE ST
MENTOR OH
44060-4937
US

IV. Provider business mailing address

7072 MAPLE ST.
MENTOR OH
44060
US

V. Phone/Fax

Practice location:
  • Phone: 440-479-2977
  • Fax:
Mailing address:
  • Phone: 440-479-2977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number024620
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number314670
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: