Provider Demographics
NPI:1194702969
Name:BENTLEY, SUSAN WARREN (CRNP)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:WARREN
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:WARREN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:2095 FLORENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-2751
Mailing Address - Country:US
Mailing Address - Phone:256-766-2310
Mailing Address - Fax:256-768-9956
Practice Address - Street 1:2095 FLORENCE BLVD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-2751
Practice Address - Country:US
Practice Address - Phone:256-766-2310
Practice Address - Fax:256-768-9956
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1031194363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL214361Medicaid