Healthcare Provider Details

I. General information

NPI: 1205372604
Provider Name (Legal Business Name): BENJAMIN CRAIG MATTHEWS ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2017
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4250 MARTIN WAY E STE 105
OLYMPIA WA
98516-5317
US

IV. Provider business mailing address

1793 13TH ST SE
SALEM OR
97302-2541
US

V. Phone/Fax

Practice location:
  • Phone: 866-599-3376
  • Fax:
Mailing address:
  • Phone: 503-362-8385
  • Fax: 503-362-8435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60724870
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: