Organization
PROVIDENCE HEALTH & SERVICES - WA
Active
Other names
Providence Physician Group - Cranial Clinic
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
2320 RUCKER AVE, SUITE A, EVERETT, WA 98201-2723
(425) 259-5121
(425) 252-1322
Mailing address
PO BOX 34439, SEATTLE, WA 98124-1439
(425) 525-6652
(425) 525-6700
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
—
—
Other
Enumeration date
10/04/2008
Last updated
07/25/2025
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