Organization
PROVIDENCE HEALTH & SERVICES - WASHINGTON
Active
Organization
PROVIDENCE HEALTH & SERVICES - WASHINGTON
Active
Other names
PMG NW WA Everett Cardiology
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
1330 ROCKEFELLER AVE, SUITE 230, EVERETT, WA 98201-1676
(425) 261-4925
(425) 261-4932
Mailing address
PO BOX 31001-4114, PASADENA, CA 91110-4114
(425) 358-9786
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
2471B0102X
Bone Densitometry Radiologic Technologist
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
363LG0600X
Gerontology Nurse Practitioner
—
—
Other
Enumeration date
10/07/2008
Last updated
05/14/2025
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