Provider Demographics
NPI:1346642196
Name:CICHON, BENJAMIN R (PA-C)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:R
Last Name:CICHON
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:11019 CANYON RD E
Mailing Address - Street 2:STE A
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-3001
Mailing Address - Country:US
Mailing Address - Phone:425-656-5060
Mailing Address - Fax:425-656-5047
Practice Address - Street 1:11019 CANYON RD E
Practice Address - Street 2:STE A
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3001
Practice Address - Country:US
Practice Address - Phone:253-537-0293
Practice Address - Fax:253-537-7650
Is Sole Proprietor?:No
Enumeration Date:2014-09-24
Last Update Date:2017-01-11
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Provider Licenses
StateLicense IDTaxonomies
WAPA60607646363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant