Healthcare Provider Details

I. General information

NPI: 1609055524
Provider Name (Legal Business Name): PAMELA ANNE BENNINGHOVEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PAMELA ANNE DUDLEY

II. Dates (important events)

Enumeration Date: 10/27/2007
Last Update Date: 05/11/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 CONSTITUTION BLVD
SALINAS CA
93906-3100
US

IV. Provider business mailing address

1441 CONSTITUTION BLVD
SALINAS CA
93906-3100
US

V. Phone/Fax

Practice location:
  • Phone: 831-755-4111
  • Fax: 831-772-7333
Mailing address:
  • Phone: 831-755-4111
  • Fax: 831-772-7333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number17428
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number17428
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: