# PROVIDENCE HEALTH & SERVICES-WA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164673554
- **Authorized official:** DONALD WAYNE ANDERSON JR. (ASST SECRETARY-ENROLLMENT)
- **Authorized official phone:** (425) 358-9786

## Contact information

- **Practice address:** 1509 CALIFORNIA ST, EVERETT, WA 98201-3540
- **Practice address phone:** (425) 297-5770
- **Practice address fax:** (425) 259-5831
- **Mailing address:** PO BOX 31001-4110, PASADENA, CA 91110-4110

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 10/04/2008
- **Last updated:** 05/07/2025