Organization
PROVIDENCE HEALTH & SERVICES - WASHINGTON
Active
Other names
Providence SMMC Nephrology DME
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
301 W POPLAR ST, SUITE 100, WALLA WALLA, WA 99362-2858
(509) 522-5824
(509) 522-5738
Mailing address
PO BOX 31001 - 4110, PASADENA, CA 91110-4110
(509) 522-5906
(509) 522-5789
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
HAC.FS.00000050
WA
Other
Enumeration date
04/27/2009
Last updated
03/06/2026
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