Healthcare Provider Details

I. General information

NPI: 1285662999
Provider Name (Legal Business Name): CRYSTAL G. BENSEN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 09/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3246 42ND AVE SW
SEATTLE WA
98116-3423
US

IV. Provider business mailing address

3246 42ND AVE SW
SEATTLE WA
98116-3423
US

V. Phone/Fax

Practice location:
  • Phone: 206-932-6221
  • Fax:
Mailing address:
  • Phone: 206-932-6221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP30006332
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNUR U 1301
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00121603
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberNUR R 34514
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: