Provider Demographics
NPI:1154561629
Name:BENTLEY, LINDSAY SAWYER (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:SAWYER
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 CREEDMOOR RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-3697
Mailing Address - Country:US
Mailing Address - Phone:919-825-4000
Mailing Address - Fax:919-803-3601
Practice Address - Street 1:6500 CREEDMOOR RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-3697
Practice Address - Country:US
Practice Address - Phone:919-825-4000
Practice Address - Fax:919-803-3601
Is Sole Proprietor?:No
Enumeration Date:2009-02-24
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001001738363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2760025Medicare PIN