Provider Demographics
NPI:1619109774
Name:BENJESTORF, LEIF (ARNP)
Entity Type:Individual
Prefix:MR
First Name:LEIF
Middle Name:
Last Name:BENJESTORF
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 1:19109 36TH AVE W
Mailing Address - Street 2:SUITE # 209
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-5767
Mailing Address - Country:US
Mailing Address - Phone:206-569-8457
Mailing Address - Fax:425-673-7586
Practice Address - Street 1:19109 36TH AVE W
Practice Address - Street 2:SUITE # 209
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5767
Practice Address - Country:US
Practice Address - Phone:206-569-8457
Practice Address - Fax:425-673-7586
Is Sole Proprietor?:No
Enumeration Date:2009-08-21
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60201664363LP0808X
WARN00174674163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse