Provider Demographics
NPI:1689004327
Name:BENDER, CAROL JOY (RNP)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:JOY
Last Name:BENDER
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:JOY
Other - Last Name:HANSELMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RNP
Mailing Address - Street 1:1094 8TH ST
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:91932-2724
Mailing Address - Country:US
Mailing Address - Phone:858-609-0866
Mailing Address - Fax:858-609-0854
Practice Address - Street 1:838 G ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-6421
Practice Address - Country:US
Practice Address - Phone:848-229-4452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-15
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000097363LA2100X, 363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health