Individual
LISA BENTLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1 GENESYS PKWY, GRAND BLANC, MI 48439-8065
(810) 606-5000
Mailing address
8601 BARNES RD, MILLINGTON, MI 48746-9548
(810) 252-2761
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704196212
MI
390200000X
Student in an Organized Health Care Education/Training Program
4704196212
MI
Other
Enumeration date
08/08/2018
Last updated
04/05/2019
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