MEDICARE: MRS. MARYANN D. BENTLEY RN, BSN, MSN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	314670	OH
2	363LF0000X	Family Nurse Practitioner	024620	OH

General Provider Information

NPI Number	:	1902196009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARYANN D. BENTLEY RN, BSN, MSN

Provider Business Mailing Address
First Line	:	7072 MAPLE ST.
Second Line	:
City	:	MENTOR
State	:	OH
Zip	:	44060
Country	:	US
Telephone Number	:	440-479-2977
Fax Number	:

Provider Business Practice Location Address
First Line	:	7072 MAPLE ST
Second Line	:
City	:	MENTOR
State	:	OH
Zip	:	44060-4937
Country	:	US
Telephone Number	:	440-479-2977
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2011
Last Update Date	:	08/31/2020

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