Basic Information
Provider Information | |||||||||
NPI: | 1508816067 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BENTLEY | ||||||||
FirstName: | NORA | ||||||||
MiddleName: | L | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | CRNA | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2215 E WATERLOO RD STE 313 | ||||||||
Address2: |   | ||||||||
City: | AKRON | ||||||||
State: | OH | ||||||||
PostalCode: | 443123856 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3302082720 | ||||||||
FaxNumber: | 3302082721 | ||||||||
Practice Location | |||||||||
Address1: | 3780 MEDINA RD STE 120 | ||||||||
Address2: |   | ||||||||
City: | MEDINA | ||||||||
State: | OH | ||||||||
PostalCode: | 442569312 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3302082720 | ||||||||
FaxNumber: | 3302082721 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/12/2006 | ||||||||
LastUpdateDate: | 11/19/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | RN-196070 | OH | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |   |
ID Information
ID | Type | State | Issuer | Description | 34-0891295 | 01 | OH | EMPLOYER FEDERAL TAX ID # | OTHER | 730617 | 01 | OH | BUCKEYE COMMUNITY HLTH PL | OTHER | 120805 | 01 | OH | KAISER PERMANENTE INDV # | OTHER | 000000125743 | 01 | OH | ANTHEM BCBS INDV NUMBER | OTHER | 7091249 | 05 | OH |   | MEDICAID | 100153 | 01 | OH | EMPLOYER KAISER GROUP # | OTHER | 0863623 | 05 | OH |   | MEDICAID | 2080224 | 01 | OH | EMP UNITED HEALTHCARE GRP | OTHER |