Organization
PROVIDENCE HEALTH & SERVICES-WA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD WAYNE ANDERSON JR. (ASST SECRETARY-ENROLLMENT)
(425) 358-9786
Entity
Organization
Contact information
Practice address
916 PACIFIC AVE, 1 SOUTH, EVERETT, WA 98201-4147
(425) 258-7390
(425) 258-7379
Mailing address
PO BOX 31001-4110, PASADENA, CA 91110-4110
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
10/07/2008
Last updated
05/07/2025
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