Provider Demographics
NPI:1205372604
Name:MATTHEWS, BENJAMIN CRAIG (ARNP)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:CRAIG
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1793 13TH ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-2541
Mailing Address - Country:US
Mailing Address - Phone:503-362-8385
Mailing Address - Fax:503-362-8435
Practice Address - Street 1:4250 MARTIN WAY E
Practice Address - Street 2:#105
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98516-5317
Practice Address - Country:US
Practice Address - Phone:360-451-2911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-10
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60724870363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily