Provider Demographics
NPI:1871004044
Name:PENDLETON, ROBIN E
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:E
Last Name:PENDLETON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 SISTER MARY COLUMBA DR
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-4356
Mailing Address - Country:US
Mailing Address - Phone:530-527-0414
Mailing Address - Fax:530-528-7920
Practice Address - Street 1:2450 SISTER MARY COLUMBA DR
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-4356
Practice Address - Country:US
Practice Address - Phone:530-527-0414
Practice Address - Fax:530-528-7920
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-16
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135130363LF0000X
CANPF95013006363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3790990-01Medicaid
TXAP135130OtherTX BOARD OF NURSING LICENSE
CANPF95013006OtherCALIFORNIA NPF LICENSE
TN182260OtherREGISTERED NURSE
TN22987OtherTN- ADVANCED PRACTICE REGISTERED NURSE