MEDICARE: MS. CRYSTAL G. BENSEN ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN00121603	WA
2	363L00000X	Nurse Practitioner	AP30006332	WA
3	163W00000X	Registered Nurse	NUR R 34514	AK
4	363LF0000X	Family Nurse Practitioner	NUR U 1301	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	25577U	OTHER	WA	REGENCE BLUE SHIELD PIN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0166566	OTHER	WA	L&I PIN

General Provider Information

NPI Number	:	1285662999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CRYSTAL G. BENSEN ARNP

Provider Business Mailing Address
First Line	:	3246 42ND AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98116-3423
Country	:	US
Telephone Number	:	206-932-6221
Fax Number	:

Provider Business Practice Location Address
First Line	:	3246 42ND AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98116-3423
Country	:	US
Telephone Number	:	206-932-6221
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	09/07/2016

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