Provider Demographics
NPI:1700324795
Name:CAROL JOY BENDER, NP, A NURSING CORPORATION
Entity Type:Organization
Organization Name:CAROL JOY BENDER, NP, A NURSING CORPORATION
Other - Org Name:CAROL JOY HANSELMAN, NURSE PRACTITIONER, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BENDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:848-229-4452
Mailing Address - Street 1:3333 CAMINO DE RIO S
Mailing Address - Street 2:STE 205
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108
Mailing Address - Country:US
Mailing Address - Phone:858-609-0866
Mailing Address - Fax:858-609-0854
Practice Address - Street 1:3333 CAMINO DE RIO S
Practice Address - Street 2:STE 205
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108
Practice Address - Country:US
Practice Address - Phone:858-609-0866
Practice Address - Fax:858-609-0854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000097261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty