Provider Demographics
NPI:1578197117
Name:BENTLEY, ANNA ELISABETH
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:ELISABETH
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:ELISABETH
Other - Last Name:KILLMEIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2856 NW VAN BUREN AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-5257
Mailing Address - Country:US
Mailing Address - Phone:678-850-0465
Mailing Address - Fax:
Practice Address - Street 1:2856 NW VAN BUREN AVE APT 3
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-5257
Practice Address - Country:US
Practice Address - Phone:678-850-0465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-22
Last Update Date:2020-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000003747374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula