Provider Demographics
NPI:1487540670
Name:BENTZ, CHANTHALA VISETSIN (RN)
Entity type:Individual
Prefix:MS
First Name:CHANTHALA
Middle Name:VISETSIN
Last Name:BENTZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6041 ASHBURY ST APT 8303
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-2052
Mailing Address - Country:US
Mailing Address - Phone:682-521-0728
Mailing Address - Fax:
Practice Address - Street 1:6041 ASHBURY ST APT 8303
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-2052
Practice Address - Country:US
Practice Address - Phone:682-521-0728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2513094163WC0400X
TX877483163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management