Provider Demographics
NPI:1285662999
Name:BENSEN, CRYSTAL G (ARNP)
Entity Type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:G
Last Name:BENSEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3246 42ND AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-3423
Mailing Address - Country:US
Mailing Address - Phone:206-932-6221
Mailing Address - Fax:
Practice Address - Street 1:3246 42ND AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-3423
Practice Address - Country:US
Practice Address - Phone:206-932-6221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00121603163W00000X
WAAP30006332363L00000X
AKNUR R 34514163W00000X
AKNUR U 1301363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA25577UOtherREGENCE BLUE SHIELD PIN
WA9635566Medicaid
WA0166566OtherL&I PIN
P82836Medicare UPIN
WA0166566OtherL&I PIN