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
900 PACIFIC AVE, FIRST FLOOR, EVERETT, WA 98201-4168
(425) 258-7311
(425) 258-7618
Mailing address
PO BOX 31001-4110, PASADENA, CA 91110-4110
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
—
—
133NN1002X
Nutrition Education Nutritionist
—
—
261QD1600X
Developmental Disabilities Clinic/Center
—
WA
282N00000X
General Acute Care Hospital
HAC.FS.00000084
WA
363L00000X
Nurse Practitioner
—
—
363LP0200X
Pediatric Nurse Practitioner
Primary
—
—
Other
Enumeration date
10/04/2008
Last updated
02/10/2026
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