Provider Demographics
NPI:1225493455
Name:BENJAMIN, ERIKA MOEN (ARNP)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:MOEN
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:ERIKA
Other - Middle Name:
Other - Last Name:MOEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:2817 NE 55TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-5536
Mailing Address - Country:US
Mailing Address - Phone:206-486-1500
Mailing Address - Fax:206-568-7043
Practice Address - Street 1:126 NW CANAL ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-4970
Practice Address - Country:US
Practice Address - Phone:206-486-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-14
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60272696163W00000X
WAAP60670978363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1225493455Medicaid