Provider Demographics
NPI:1417246067
Name:BENNER, CHRISTOPHER W (ARNP)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:W
Last Name:BENNER
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 1:1029 N KELLOGG ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7661
Mailing Address - Country:US
Mailing Address - Phone:509-735-9355
Mailing Address - Fax:509-222-1151
Practice Address - Street 1:1776 FOWLER ST
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4833
Practice Address - Country:US
Practice Address - Phone:509-735-9355
Practice Address - Fax:509-222-1151
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP300007044363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0199091OtherDEPT OF LABOR & INDUSTRIES
E53821Medicare UPIN
WA0199091OtherDEPT OF LABOR & INDUSTRIES