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
3305 NASSAU ST, EVERETT, WA 98201-4140
(425) 261-3838
(425) 261-3848
Mailing address
PO BOX 31001-4110, PASADENA, CA 91110-4110
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
—
—
261Q00000X
Clinic/Center
Primary
—
—
261QH0100X
Health Service Clinic/Center
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
08/25/2010
Last updated
05/07/2025
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