Organization
PROVIDENCE HEALTH & SERVICES-WA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DONALD WAYNE ANDERSON JR. (ASSIST SECRETARY-ENROLLMENT)
(425) 358-9786
Entity
Organization
Contact information
Practice address
1321 COLBY AVE, EVERETT, WA 98201-1665
(425) 261-3968
(425) 261-3967
Mailing address
PO BOX 31001-4110, PASADENA, CA 91110-4110
Taxonomy
Speciality
Code
Description
License number
State
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
10/07/2008
Last updated
05/13/2025
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