Healthcare Provider Details

I. General information

NPI: 1780749291
Provider Name (Legal Business Name): TERESA SUE BENTLEY RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 SPRING VALLEY DR
HUNTINGTON WV
25704-9300
US

IV. Provider business mailing address

1540 SPRING VALLEY DR
HUNTINGTON WV
25704-9300
US

V. Phone/Fax

Practice location:
  • Phone: 304-429-6755
  • Fax: 304-429-0350
Mailing address:
  • Phone: 304-429-6755
  • Fax: 304-429-0350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number23457
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: