Healthcare Provider Details

I. General information

NPI: 1689004327
Provider Name (Legal Business Name): CAROL JOY BENDER R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROL JOY HANSELMAN R.N.P.

II. Dates (important events)

Enumeration Date: 11/15/2013
Last Update Date: 09/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

838 G ST
SAN DIEGO CA
92101-6421
US

IV. Provider business mailing address

1094 8TH ST
IMPERIAL BEACH CA
91932-2724
US

V. Phone/Fax

Practice location:
  • Phone: 848-229-4452
  • Fax:
Mailing address:
  • Phone: 858-609-0866
  • Fax: 858-609-0854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95000097
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95000097
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95000097
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: