Provider Demographics
NPI:1174872469
Name:BENTLEY, SIMONE NATASHA (APRN)
Entity type:Individual
Prefix:MISS
First Name:SIMONE
Middle Name:NATASHA
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Mailing Address - Street 1:40 S MAIN ST
Mailing Address - Street 2:STE 1300
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-5513
Mailing Address - Country:US
Mailing Address - Phone:901-422-7617
Mailing Address - Fax:
Practice Address - Street 1:9900 BREN RD E
Practice Address - Street 2:MAIL ROUTE MN 008-B213
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55343-9664
Practice Address - Country:US
Practice Address - Phone:860-967-2723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-03
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT5151363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health