Healthcare Provider Details

I. General information

NPI: 1790181816
Provider Name (Legal Business Name): ERIN BENNETT MSN, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2014
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15230 LAKESHORE DR STE 103
CLEARLAKE CA
95422-8107
US

IV. Provider business mailing address

9320 KELSEY CREEK DR
KELSEYVILLE CA
95451-8031
US

V. Phone/Fax

Practice location:
  • Phone: 707-995-4545
  • Fax: 707-995-4543
Mailing address:
  • Phone: 707-355-0115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95029013
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9501509
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: