Healthcare Provider Details

I. General information

NPI: 1730139007
Provider Name (Legal Business Name): MOLLY L. BENNETT-KAUFMAN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 02/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC ST
SEATTLE WA
98195-0001
US

IV. Provider business mailing address

PO BOX 24366
SEATTLE WA
98124-0366
US

V. Phone/Fax

Practice location:
  • Phone: 206-598-3000
  • Fax: 206-598-3040
Mailing address:
  • Phone: 206-598-0502
  • Fax: 206-598-0516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00038832
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP30000511
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP30000511
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: