Provider Demographics
NPI:1679990089
Name:WEBSTER, ERIC WILLIAM (ARNP)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:WILLIAM
Last Name:WEBSTER
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 1:450 S KITSAP BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-3773
Mailing Address - Country:US
Mailing Address - Phone:360-744-6275
Mailing Address - Fax:360-479-0108
Practice Address - Street 1:450 S KITSAP BLVD
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-3773
Practice Address - Country:US
Practice Address - Phone:360-744-6275
Practice Address - Fax:360-479-0108
Is Sole Proprietor?:No
Enumeration Date:2014-03-24
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00166538163W00000X
WAAP60443170363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2036580Medicaid