Provider Demographics
NPI:1386931426
Name:BENNETT, NICK FOSTER (DO)
Entity type:Individual
Prefix:DR
First Name:NICK
Middle Name:FOSTER
Last Name:BENNETT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6401 KIMBALL DR STE 201
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1228
Mailing Address - Country:US
Mailing Address - Phone:253-858-9192
Mailing Address - Fax:253-858-4348
Practice Address - Street 1:6401 KIMBALL DR STE 201
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1228
Practice Address - Country:US
Practice Address - Phone:253-858-9192
Practice Address - Fax:253-858-4348
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE974207Q00000X
WAOP61658852207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine