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General NPI Number Information
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NPI Number | 1568838944
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Entity Type | Organization
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Legal Business Name | BENTZCO LLC
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Dates
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Enumeration Date | 08/19/2015
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Last Update Date | 08/19/2015
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Provider Practice Location Address
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Address Line | 3777 THE AMERICAN RD NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-1338
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Country | US
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Telephone | 505-890-2185
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Fax | 505-890-2168
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Provider Business Mailing Address
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Address Line | 5 HIGHWAY 474
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City | ALGODONES
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State | NM
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Zip | 87001-8028
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Country | US
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Telephone | 505-818-8588
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Fax | 505-890-2168
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Authorized Official
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Title or Position | CLINIC ADMINISTRATOR/PROVIDER
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Name | MS. RHONDA K BENTZ
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Credential | C.FNP
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Telephone | 505-890-2185
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | CNP00238
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License Number State | NM
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