Provider Demographics
NPI:1316972391
Name:BENTLEY, MARY E (CRNA)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:E
Other - Last Name:HUSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:303 S BROADWAY
Mailing Address - Street 2:SUITE 200-327
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-1558
Mailing Address - Country:US
Mailing Address - Phone:814-746-2776
Mailing Address - Fax:
Practice Address - Street 1:303 S BROADWAY
Practice Address - Street 2:SUITE 200-327
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-1558
Practice Address - Country:US
Practice Address - Phone:814-746-2776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA127825367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAQ22419Medicare UPIN
GA43BBBXGMedicare ID - Type UnspecifiedANESTHESIA