Healthcare Provider Details

I. General information

NPI: 1871004044
Provider Name (Legal Business Name): ROBIN E PENDLETON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2017
Last Update Date: 12/09/2019
Certification Date: 12/09/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 SISTER MARY COLUMBA DR
RED BLUFF CA
96080-4356
US

IV. Provider business mailing address

2450 SISTER MARY COLUMBA DR
RED BLUFF CA
96080-4356
US

V. Phone/Fax

Practice location:
  • Phone: 530-527-0414
  • Fax: 530-528-7920
Mailing address:
  • Phone: 530-527-0414
  • Fax: 530-528-7920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP135130
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNPF95013006
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: