1871004044 NPI number — ROBIN E PENDLETON

Table of content: ROBIN E PENDLETON (NPI 1871004044)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871004044 NPI number — ROBIN E PENDLETON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PENDLETON
Provider First Name:
ROBIN
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871004044
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2450 SISTER MARY COLUMBA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RED BLUFF
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
96080-4356
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-527-0414
Provider Business Mailing Address Fax Number:
530-528-7920

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2450 SISTER MARY COLUMBA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RED BLUFF
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96080-4356
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-527-0414
Provider Business Practice Location Address Fax Number:
530-528-7920
Provider Enumeration Date:
10/16/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  AP135130 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: NPF95013006 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3790990-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: AP135130 . This is a "TX BOARD OF NURSING LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: NPF95013006 . This is a "CALIFORNIA NPF LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 182260 . This is a "REGISTERED NURSE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 22987 . This is a "TN- ADVANCED PRACTICE REGISTERED NURSE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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