Healthcare Provider Details

I. General information

NPI: 1538122734
Provider Name (Legal Business Name): BENJAMIN D. WEAVER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC ST BOX 356540
SEATTLE WA
98195-0001
US

IV. Provider business mailing address

PO BOX 24975 359107
SEATTLE WA
98124-0975
US

V. Phone/Fax

Practice location:
  • Phone: 206-598-4260
  • Fax: 206-598-8812
Mailing address:
  • Phone: 206-598-8920
  • Fax: 206-598-7663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00136294
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP30006644
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: