Provider Demographics
NPI:1679011654
Name:WEBBER, MATTHEW BLAKE (ARNP)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:BLAKE
Last Name:WEBBER
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 1:11511 CANTERWOOD BLVD STE 320
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-5813
Mailing Address - Country:US
Mailing Address - Phone:253-857-1350
Mailing Address - Fax:253-857-1399
Practice Address - Street 1:11511 CANTERWOOD BLVD STE 320
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98332-5813
Practice Address - Country:US
Practice Address - Phone:253-857-1350
Practice Address - Fax:253-857-1399
Is Sole Proprietor?:No
Enumeration Date:2017-02-09
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60725065363L00000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2076008Medicaid