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General NPI Number Information
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NPI Number | 1790181816
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Entity Type | Individual
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Provider Name | ERIN BENNETT MSN, APRN, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 11/17/2014
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Last Update Date | 02/26/2025
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Provider Practice Location Address
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Address Line | 15230 LAKESHORE DR STE 103
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City | CLEARLAKE
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State | CA
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Zip | 95422-8107
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Country | US
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Telephone | 707-995-4545
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Fax | 707-995-4543
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Provider Business Mailing Address
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Address Line | 9320 KELSEY CREEK DR
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City | KELSEYVILLE
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State | CA
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Zip | 95451-8031
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Country | US
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Telephone | 707-355-0115
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 95029013
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 9501509
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License Number State | CA
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