Provider Demographics
NPI:1730772633
Name:BENTELE, KIMBERLEY A (APRN, CNP)
Entity type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:A
Last Name:BENTELE
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 STATION DR STE 300
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-8003
Mailing Address - Country:US
Mailing Address - Phone:815-455-1800
Mailing Address - Fax:815-455-1875
Practice Address - Street 1:360 STATION DR STE 300
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-8003
Practice Address - Country:US
Practice Address - Phone:815-455-1800
Practice Address - Fax:815-455-1875
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209022603363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner