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Organization
PROVIDENCE HEALTH & SERVICES-WA
Active
Organization
PROVIDENCE HEALTH & SERVICES-WA
Active
Other names
PMG NW WA Pacific Midwifery
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
916 PACIFIC AVE, 7TH FLOOR, EVERETT, WA 98201-4147
(425) 303-6500
(425) 303-6550
Mailing address
PO BOX 3360, PORTLAND, OR 97208-3360
(866) 399-2983
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
NULL
104100000X
Social Worker
—
—
133V00000X
Registered Dietitian
—
NULL
133V00000X
Registered Dietitian
—
—
163W00000X
Registered Nurse
—
NULL
163W00000X
Registered Nurse
—
—
363LP0200X
Pediatric Nurse Practitioner
—
NULL
363LP0200X
Pediatric Nurse Practitioner
—
—
364SW0102X
Women's Health Clinical Nurse Specialist
—
NULL
364SW0102X
Women's Health Clinical Nurse Specialist
—
—
367A00000X
Advanced Practice Midwife
Primary
—
NULL
367A00000X
Advanced Practice Midwife
Primary
—
—
Other
Enumeration date
10/07/2008
Last updated
08/05/2025
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