Provider Demographics
NPI:1790181816
Name:BENNETT, ERIN (MSN, APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:BENNETT
Suffix:
Gender:
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9320 KELSEY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:KELSEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95451-8031
Mailing Address - Country:US
Mailing Address - Phone:707-355-0115
Mailing Address - Fax:
Practice Address - Street 1:15230 LAKESHORE DR STE 103
Practice Address - Street 2:
Practice Address - City:CLEARLAKE
Practice Address - State:CA
Practice Address - Zip Code:95422-8107
Practice Address - Country:US
Practice Address - Phone:707-995-4545
Practice Address - Fax:707-995-4543
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-17
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95029013163W00000X
CA9501509363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse