Provider Demographics
NPI:1609055524
Name:BENNINGHOVEN, PAMELA ANNE (NP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:ANNE
Last Name:BENNINGHOVEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:ANNE
Other - Last Name:DUDLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1441 CONSTITUTION BLVD
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93906-3100
Mailing Address - Country:US
Mailing Address - Phone:831-755-4111
Mailing Address - Fax:831-772-7333
Practice Address - Street 1:1441 CONSTITUTION BLVD
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-3100
Practice Address - Country:US
Practice Address - Phone:831-755-4111
Practice Address - Fax:831-772-7333
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-27
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17428163W00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse