Provider Demographics
NPI:1306283841
Name:BENTLEY, MELISSA CLAIRE (APN)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:CLAIRE
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 DIXON AVE
Mailing Address - Street 2:
Mailing Address - City:BOONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07005-2026
Mailing Address - Country:US
Mailing Address - Phone:973-452-7628
Mailing Address - Fax:
Practice Address - Street 1:1777 HAMBURG TPKE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-5211
Practice Address - Country:US
Practice Address - Phone:973-831-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-23
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00431800363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health